Provider Demographics
NPI:1821346735
Name:BOSL, CHAD (LMFT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BOSL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 2ND ST S
Mailing Address - Street 2:SUITE #180
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-4528
Mailing Address - Country:US
Mailing Address - Phone:320-257-1800
Mailing Address - Fax:320-257-1801
Practice Address - Street 1:101 DEHLER DR
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4407
Practice Address - Country:US
Practice Address - Phone:320-253-3512
Practice Address - Fax:320-253-1037
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist