Healthcare Provider Details

I. General information

NPI: 1922123645
Provider Name (Legal Business Name): JON S BOS PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CENTER POINT RD STE 2350
COLUMBIA SC
29210-5826
US

IV. Provider business mailing address

2000 CENTER POINT RD STE 2350
COLUMBIA SC
29210-5826
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-8887
  • Fax: 803-699-8824
Mailing address:
  • Phone: 803-699-8887
  • Fax: 803-699-8824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301010098
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1382
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number202170
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1382
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: