=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952342008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETTY BOLTE LCP, LCAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 02/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 814 CAROLINE AVE
-----------------------------------------------------
City | JUNCTION CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66441-5210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-762-5250
-----------------------------------------------------
Fax | 785-762-2144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 747
-----------------------------------------------------
City | MANHATTAN
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66505-0747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-587-4300
-----------------------------------------------------
Fax | 785-587-4377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 476
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 0517
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 904
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------