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General NPI Number Information
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NPI Number | 1356677421
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Entity Type | Individual
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Provider Name | BRIAN KEITH BOLEN PSY. D., L.M.H.C.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 3903 NORTHDALE BLVD STE 100-47
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City | TAMPA
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State | FL
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Zip | 33624-1864
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Country | US
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Telephone | 813-817-8498
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Fax | 813-406-5158
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Provider Business Mailing Address
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Address Line | 4651 WANDERING WAY
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-8500
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Country | US
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Telephone | 813-907-0285
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Fax | 813-406-5158
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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 | MH8545
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP 2482
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 8545
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License Number State | FL
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