Doctor Name: | MRS. DIANE M BOLEY |
NPI Number: | 1164448791 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 888 |
Business Practice Address: | 15 Pike St Havre, MT - 595014438 |
Business Phone Number: | 4062656602 |
Business Fax Number: | 4062652592 |
Mailing Address: | 15 Pike St, HAVRE |
State: | MT |
Postal Code: | 595014438 |
Phone Number: | 4062656602 |
Fax Number: | 4062652592 |
NPI Enumeration Date: | 07/15/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 888 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |