MEDICARE: SERI BOSSE MS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1578172870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERI BOSSE MS

Provider Business Mailing Address
First Line	:	PO BOX 10235
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25357-0235
Country	:	US
Telephone Number	:	304-444-9584
Fax Number	:

Provider Business Practice Location Address
First Line	:	1506 KANAWHA BLVD W
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25387-2533
Country	:	US
Telephone Number	:	304-444-9584
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	11/04/2021

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