Roger Boleyn, Case Manager
Counselor, Mental Health in Jackson, TN. Individual provider (NPI-1).
NPI number1295857753
StatusActive
Last updated in NPPESAug 6, 2009
Details
- NPI
- 1295857753
- Entity type
- Individual (NPI-1)
- Name
- Roger Boleyn
- Credential
- Case Manager
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 4, 2007
- Last updated
- Aug 6, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YM0800X | Counselor, Mental Health | – | – | Yes |
| 171M00000X | Case Manager/Care Coordinator | – | – |
Practice location
238 Summar DrJackson, TN 38301-3906
Phone 731-935-8200
Mailing address
1804 Highway 45 BypSuite 604
Jackson, TN 38305-4436
Phone 731-660-8759
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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