Provider Demographics
NPI:1831884675
Name:BOSHELL, SAMUEL CALEB (MS, MFTA)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:CALEB
Last Name:BOSHELL
Suffix:
Gender:M
Credentials:MS, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BROOKSLANDING DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-8699
Mailing Address - Country:US
Mailing Address - Phone:256-945-0879
Mailing Address - Fax:
Practice Address - Street 1:545 ROARK TRCE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-6328
Practice Address - Country:US
Practice Address - Phone:205-706-2905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health