Robert John Bouley, MA, LPCC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CC00576 Issued in MN

Practice address

7300 147TH St W Ste 204
Apple Valley, MN 55124-7850

Phone

(952) 997-3020

Fax

(952) 997-3026

NPI assigned

Apr 17, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nystrom & Associates, LTD

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment Care Compare group NPD
• Family Support Services Inc.

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)
• Vanda Counseling and Psychological Services

  • Community/Behavioral Health Agency
  • Golden Valley, MN
  • NPI 1295131779
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546214400000",
    "number": "1831532159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 147TH ST W STE 204",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247850",
            "telephone_number": "952-997-3020",
            "fax_number": "952-997-3026"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4969 Olson Memorial Hwy",
            "address_purpose": "LOCATION",
            "city": "Golden Valley",
            "state": "MN",
            "postal_code": "554225138",
            "country_code": "US",
            "telephone_number": "763-575-8086",
            "fax_number": "320-774-0415",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1315 Girard Ave N",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554113128",
            "country_code": "US",
            "telephone_number": "612-230-6270 x2502",
            "fax_number": "612-522-7061",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14115 James Rd Ste 305",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "MN",
            "postal_code": "55374",
            "country_code": "US",
            "telephone_number": "763-575-8086",
            "fax_number": "320-774-0415",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOULEY",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "credential": "MA, LPCC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-17",
        "last_updated": "2018-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "CC00576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Bolin, P.A.
• Christine Marie Bomsta, CMT
• Elizabeth Bonifacic, LADC
• Carol Lynn Borden, PH.D., LPCC
• Both and Resources PLLC
• Motunrayo W. Boyinbode
• Mark L Brancel, MD
• Constance H Braun, FNP
• Randy Lee Briesacher, D.C.
• Bright Horizons Therapy LLC

• Counselor in Apple Valley, MN
• Providers in Apple Valley, MN by specialty
• Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.