Healthcare Provider Details

I. General information

NPI: 1932117348
Provider Name (Legal Business Name): HAUTINA K BOLLINGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3861 LONG PRAIRIE RD SUITE 107
FLOWER MOUND TX
75028-1569
US

IV. Provider business mailing address

3861 LONG PRAIRIE RD SUITE 107
FLOWER MOUND TX
75028-1569
US

V. Phone/Fax

Practice location:
  • Phone: 214-356-4329
  • Fax: 972-691-2342
Mailing address:
  • Phone: 214-356-4329
  • Fax: 972-691-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number25332
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number25332
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: