MEDICARE: KURTISS E BOLDT PHD

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	101YM0800X	Mental Health Counselor	2625	NC

General Provider Information

NPI Number	:	1386837979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KURTISS E BOLDT PHD

Provider Business Mailing Address
First Line	:	7474-315 CREEDMOOR RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1663
Country	:	US
Telephone Number	:	919-456-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	7474 CREEDMOOR RD
Second Line	:	STE 315
City	:	RALEIGH
State	:	NC
Zip	:	27613-1663
Country	:	US
Telephone Number	:	919-460-0615
Fax Number	:

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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Directions to “ KURTISS E BOLDT PHD” Practice Location

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