MEDICARE: KARI LYN DE BOER LPC, ATR, RYT

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	6401011193
2	101Y00000X	Counselor	6401011193	MI

General Provider Information

NPI Number	:	1710287073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI LYN DE BOER LPC, ATR, RYT

Provider Business Mailing Address
First Line	:	PO BOX 6463
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-6463
Country	:	US
Telephone Number	:	231-590-8650
Fax Number	:	231-642-9101

Provider Business Practice Location Address
First Line	:	1212 VETERANS DR STE 206
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4734
Country	:	US
Telephone Number	:	231-590-8650
Fax Number	:	231-642-9101

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

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	10/05/2022

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