MEDICARE: DIANE BOLTON

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	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922036391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE BOLTON

Provider Business Mailing Address
First Line	:	8180 CLEARVISTA PKWY
Second Line	:	230
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-5629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 E HENDRICKS ST
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-2124
Country	:	US
Telephone Number	:	317-392-2564
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/08/2007

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Directions to “ DIANE BOLTON ” Practice Location

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