1205314705 NPI number — ROBYN ANN BOLES LCSW, LCDC

Table of content: ROBYN ANN BOLES LCSW, LCDC (NPI 1205314705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205314705 NPI number — ROBYN ANN BOLES LCSW, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLES
Provider First Name:
ROBYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN BOLES
Provider Other First Name:
ROBYN
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW, LCDC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205314705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 532
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75456-0532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-374-8040
Provider Business Mailing Address Fax Number:
903-205-1779

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3740 FARM ROAD 1735
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75455-0928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-374-8040
Provider Business Practice Location Address Fax Number:
903-205-1779
Provider Enumeration Date:
08/06/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  13185 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 61641 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)