Healthcare Provider Details

I. General information

NPI: 1376169268
Provider Name (Legal Business Name): BOLIN COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 ROUND ROCK WEST DR STE E222
ROUND ROCK TX
78681-5052
US

IV. Provider business mailing address

555 ROUND ROCK WEST DR STE E222
ROUND ROCK TX
78681-5052
US

V. Phone/Fax

Practice location:
  • Phone: 512-952-2122
  • Fax: 512-793-8886
Mailing address:
  • Phone: 512-952-2122
  • Fax: 512-793-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK BOLIN
Title or Position: OWNER
Credential: LPC
Phone: 512-952-2122