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NPI Code Detail

MEDICARE: MRS. KADIE ELIZABETH BOLTON MA., BCBA, LBA

MEDICARE: MRS. KADIE ELIZABETH BOLTON MA., BCBA, LBA
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
1103K00000XBehavior Analyst4748TX

General Provider Information

NPI Number : 1588206007
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KADIE ELIZABETH BOLTON MA., BCBA, LBA
Provider Business Mailing Address
First Line : 308 RANCHITO PASS
Second Line :
City : HASLET
State : TX
Zip : 76052-3647
Country : US
Telephone Number : 817-899-4659
Fax Number :
Provider Business Practice Location Address
First Line : 1652 KELLER PKWY STE 200
Second Line :
City : KELLER
State : TX
Zip : 76248-3877
Country : US
Telephone Number : 682-291-9910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2019
Last Update Date : 09/06/2023

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