Jeremy Adam Bolles, T-LMHC
Individual provider Active NPI Professional Counselor · Johnston, IA
NPI 1962200477 · NPPES record last updated Mar 3, 2025
Key facts
- NPI
- 1962200477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 129860 (IA)
- Practice address
- 5415 NW 88TH St Ste 100
Johnston, IA 50131-2951 - Phone
- (515) 727-1338
- NPI assigned
- Mar 3, 2025
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 129860 | IA | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 129860 | IA | Yes |
Addresses
Primary practice location
5415 NW 88TH St Ste 100
Johnston, IA 50131-2951
Mailing address
2021 Polk Dr
Ames, IA 50010-4316
Phone (515) 203-1918
Other providers in Johnston, IA
- Rachel Nicole Blankenship
- Hannah Nicole Block
- Joseph Bochung
- Lynde Boettcher
- Alexandra Nichole Bogener
- Gabrielle Marie Boydston
- Kayla Brady
- Braincare, LLC
- Lisa Jean Bramer
- Leah Jeanine Brandon
All providers in Johnston, IA · Professional Counselor in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.