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Individual

MS. LARA SKYE BOUGHMAN

Active
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Individual

MS. LARA SKYE BOUGHMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC, CSAC

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5352-125
WI
1041C0700X
Clinical Social Worker
15459-132
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
14277-130
SAC-IT
WI
01
15459-132
CSAC
WI
01
5352-125
LPC
WI
Enumeration date
05/22/2007
Last updated
08/26/2024
About Stedi
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  • EDI platform