MEDICARE: DR. VIRGIE BAY NOLTE ED.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
1	103TC1900X	Counseling Psychologist	22599	TX

General Provider Information

NPI Number	:	1649327123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGIE BAY NOLTE ED.D.

Provider Business Mailing Address
First Line	:	8441 STATE HWY 47
Second Line	:	STE 4300
City	:	BRYAN
State	:	TX
Zip	:	77807-3235
Country	:	US
Telephone Number	:	979-776-4035
Fax Number	:	979-776-4251

Provider Business Practice Location Address
First Line	:	8441 STATE HWY 47
Second Line	:	STE 4300
City	:	BRYAN
State	:	TX
Zip	:	77807-3235
Country	:	US
Telephone Number	:	979-776-4035
Fax Number	:	979-776-4251

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

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	09/07/2011

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