Provider Demographics
NPI:1013028299
Name:BOELTER, DEBORAH SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUE
Last Name:BOELTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 KNOLL TRAIL
Mailing Address - Street 2:STE 380
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-458-7180
Mailing Address - Fax:214-219-5008
Practice Address - Street 1:15400 KNOLL TRAIL
Practice Address - Street 2:STE 380
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248
Practice Address - Country:US
Practice Address - Phone:972-458-7180
Practice Address - Fax:214-219-5008
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24123103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling