MEDICARE: MRS. LILIAN INUTU BOLLERS LCSW-C, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	15529	MD
2	1041C0700X	Clinical Social Worker	LC50078619	DC
3	1041C0700X	Clinical Social Worker	56962	TX

General Provider Information

NPI Number	:	1003133992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILIAN INUTU BOLLERS LCSW-C, LICSW

Provider Business Mailing Address
First Line	:	7101 CHASE OAKS BLVD APT 128
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-5909
Country	:	US
Telephone Number	:	240-631-8387
Fax Number	:	240-631-2330

Provider Business Practice Location Address
First Line	:	7101 CHASE OAKS BLVD 128
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-5909
Country	:	US
Telephone Number	:	240-731-0457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	07/10/2015

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