Active NPI
Robert Edwayne Bodell
- Professional Counselor
- Benzonia, MI
National Provider Identifier
1972828465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401003816
- Practice address
- 8137 Love Road
Benzonia, MI 49616 - Phone
- (231) 882-4820
- NPI assigned
- Mar 29, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401003816 | MI | Primary |
Addresses
Primary practice location
8137 Love Road
Benzonia, MI 49616
Mailing address
PO Box 142
Benzonia, MI 49616-0142
Phone (231) 882-4820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401003816 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269820800000",
"number": "1972828465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 142",
"city": "BENZONIA",
"state": "MI",
"postal_code": "496160142",
"telephone_number": "231-882-4820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8137 LOVE ROAD",
"city": "BENZONIA",
"state": "MI",
"postal_code": "49616",
"telephone_number": "231-882-4820"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODELL",
"first_name": "ROBERT",
"middle_name": "EDWAYNE",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-29",
"last_updated": "2010-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401003816",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Benzonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.