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General NPI Number Information
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NPI Number | 1598321721
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Entity Type | Organization
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Legal Business Name | JEANNETTE BOLTE, PH.D, PLLC
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 01/16/2021
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Provider Practice Location Address
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Address Line | 8933C LORRAINE RD
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City | GULFPORT
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State | MS
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Zip | 39503-4176
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Country | US
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Telephone | 228-897-7730
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Fax | 228-575-0886
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Provider Business Mailing Address
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Address Line | 8933C LORRAINE RD
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City | GULFPORT
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State | MS
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Zip | 39503-4176
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Country | US
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Telephone | 228-897-7730
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Fax | 228-575-0886
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. JEANNETTE BOLTE
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Credential | PH.D
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Telephone | 288-596-5407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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