Individual
MS. LARA SKYE BOUGHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
4785 HAYES RD STE 200, MADISON, WI 53704-7364
(608) 844-8473
(608) 400-8422
Mailing address
4785 HAYES RD STE 200, MADISON, WI 53704-7364
(608) 844-8473
(608) 400-8422
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
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