| Doctor Name: | MRS. KELLEY MARIE BOLTIN |
| NPI Number: | 1083985733 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S. LPC |
| License Number: | LPC 1475 |
| Business Practice Address: | 405 W Boxelder Rd Ste C8 Gillette, WY - 827185320 |
| Business Phone Number: | 3076894185 |
| Business Fax Number: | 3076894185 |
| Mailing Address: | 405 W Boxelder Rd Ste A1, GILLETTE |
| State: | WY |
| Postal Code: | 827185320 |
| Phone Number: | 3076867779 |
| Fax Number: | 3076869494 |
| NPI Enumeration Date: | 01/25/2012 |
| NPI Last Update Date: | 01/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC 1475 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |