Provider Demographics
NPI:1689958209
Name:CARTER-BOOMSMA, AMANDA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:CARTER-BOOMSMA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E 41ST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6048
Mailing Address - Country:US
Mailing Address - Phone:605-357-0100
Mailing Address - Fax:605-357-0140
Practice Address - Street 1:1424 9TH AVE SE
Practice Address - Street 2:SUITE 7
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-5383
Practice Address - Country:US
Practice Address - Phone:605-882-2740
Practice Address - Fax:605-882-4323
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC7090101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor