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General NPI Number Information
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NPI Number | 1245574912
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Entity Type | Organization
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Legal Business Name | BOLTE PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 305 ARTILLERY PARK DR SUITE 102
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City | FORT MITCHELL
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State | KY
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Zip | 41017-2781
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Country | US
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Telephone | 859-426-0200
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Fax | 859-426-0042
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Provider Business Mailing Address
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Address Line | 305 ARTILLERY PARK DR SUITE 102
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City | FORT MITCHELL
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State | KY
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Zip | 41017-2781
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Country | US
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Telephone | 859-426-0200
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Fax | 859-426-0042
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LAURA R. BOLTE
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Credential | PH.D.
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Telephone | 859-426-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1298
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License Number State | KY
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