MEDICARE: BOSS COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295444636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	1418 N FRANKLIN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7718
Country	:	US
Telephone Number	:	616-644-7220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 N FRANKLIN ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7718
Country	:	US
Telephone Number	:	616-644-7220
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELSIE BOSS
Credential	:	LPCC
Telephone Number	:	616-644-7220

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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