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NPI Code Detail

MEDICARE: BETTY BOLTE LCP, LCAC

MEDICARE: BETTY BOLTE LCP, LCAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor476KS
2103T00000XPsychologist0517KS
3103T00000XPsychologist904KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111658758OTHERCAQH
2856659OTHERKSBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952342008
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY BOLTE LCP, LCAC
Provider Business Mailing Address
First Line : PO BOX 747
Second Line :
City : MANHATTAN
State : KS
Zip : 66505-0747
Country : US
Telephone Number : 785-587-4300
Fax Number : 785-587-4377
Provider Business Practice Location Address
First Line : 814 CAROLINE AVE
Second Line :
City : JUNCTION CITY
State : KS
Zip : 66441-5210
Country : US
Telephone Number : 785-762-5250
Fax Number : 785-762-2144
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 02/06/2019

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