Doctor Name: | MR. FREDERICK DAVID BOLEY |
NPI Number: | 1467858936 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | 2014033260 |
Business Practice Address: | 741 N Business Route 5 Camdenton, MO - 650202643 |
Business Phone Number: | 5733179100 |
Business Fax Number: | |
Mailing Address: | 741 N Business Route 5, CAMDENTON |
State: | MO |
Postal Code: | 650202643 |
Phone Number: | 5733179100 |
Fax Number: | |
NPI Enumeration Date: | 11/11/2014 |
NPI Last Update Date: | 11/11/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2014033260 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |