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General NPI Number Information
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NPI Number | 1275959322
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Entity Type | Individual
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Provider Name | MS. KARI KAY BOULDIN
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Gender | Female
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 4445 PINE FOREST DR
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City | LAKE WORTH
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State | FL
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Zip | 33463-4676
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Country | US
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Telephone | 561-214-9259
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Fax |
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Provider Business Mailing Address
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Address Line | 501 SHADY PINE WAY APT A2
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City | GREENACRES
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State | FL
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Zip | 33415-8906
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Country | US
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Telephone | 561-628-1223
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT2852
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License Number State | FL
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