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NPI Code Detail

MEDICARE: JOSHUA P BOULTER

MEDICARE: JOSHUA P BOULTER
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
1101YM0800XMental Health Counselor82627TX

General Provider Information

NPI Number : 1417581794
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA P BOULTER
Provider Business Mailing Address
First Line : 6413 BLUEBONNET DR
Second Line :
City : ROWLETT
State : TX
Zip : 75089-1683
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 920 18TH ST
Second Line :
City : PLANO
State : TX
Zip : 75074-5831
Country : US
Telephone Number : 254-396-0614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2020
Last Update Date : 11/27/2023

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Directions to “ JOSHUA P BOULTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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