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NPI Code Detail

MEDICARE: LANNY CLARICE BOLLING PSY.D.

MEDICARE: LANNY CLARICE BOLLING PSY.D.
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
1103TC0700XClinical PsychologistP2824TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103I681458OTHERTNMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)

General Provider Information

NPI Number : 1578696944
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANNY CLARICE BOLLING PSY.D.
Provider Business Mailing Address
First Line : 108 W SUMMIT HILL DR
Second Line :
City : KNOXVILLE
State : TN
Zip : 37902-1025
Country : US
Telephone Number : 865-525-1099
Fax Number : 865-525-7494
Provider Business Practice Location Address
First Line : 101 MED TECH PKWY STE 200
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-4001
Country : US
Telephone Number : 423-232-6120
Fax Number : 423-232-6125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/20/2023

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