Healthcare Provider Details

I. General information

NPI: 1215454111
Provider Name (Legal Business Name): PHIL T. BOLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

IV. Provider business mailing address

885 E BUCHTEL AVE
AKRON OH
44305-2338
US

V. Phone/Fax

Practice location:
  • Phone: 330-535-8181
  • Fax:
Mailing address:
  • Phone: 330-535-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0600244
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: