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General NPI Number Information
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NPI Number | 1265980593
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Entity Type | Individual
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Provider Name | KATELYN BOLES LPC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 206 LEVESQUE AVE E
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City | WYNNE
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State | AR
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Zip | 72396-2938
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Country | US
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Telephone | 870-351-0312
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Fax |
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Provider Business Mailing Address
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Address Line | 10 COUNTY ROAD 367
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City | WYNNE
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State | AR
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Zip | 72396-8079
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Country | US
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Telephone | 703-510-3128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1609114
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P1904050
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License Number State | AR
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