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General NPI Number Information
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NPI Number | 1992167951
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Entity Type | Organization
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Legal Business Name | AMANDA CARTER-BOOMSMA
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 100 S MAPLE STE 204
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City | WATERTOWN
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State | SD
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Zip | 57201-3772
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Country | US
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Telephone | 605-450-5490
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Fax |
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Provider Business Mailing Address
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Address Line | 412 ASH ST
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City | FRANKFORT
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State | SD
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Zip | 57440-2112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | AMANDA CARTER-BOOMSMA
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Credential | LPCMH
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Telephone | 605-460-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPCMH2229
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License Number State | SD
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