MEDICARE: ANDREW J BOEKESTEIN LPC

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	101YP2500X	Professional Counselor	6401012220	MI

General Provider Information

NPI Number	:	1962716563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW J BOEKESTEIN LPC

Provider Business Mailing Address
First Line	:	1801 TIMBER CANYON DR SE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-8772
Country	:	US
Telephone Number	:	616-528-2846
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 TIMBER CANYON DR SE
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-8772
Country	:	US
Telephone Number	:	616-202-3055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	03/03/2026

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