Provider Demographics
NPI:1164567350
Name:BOLDING, BARBARA MYERS (MED)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MYERS
Last Name:BOLDING
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S AUSTIN AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5707
Mailing Address - Country:US
Mailing Address - Phone:512-869-1152
Mailing Address - Fax:512-869-1145
Practice Address - Street 1:624 S AUSTIN AVE
Practice Address - Street 2:STE 220
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5707
Practice Address - Country:US
Practice Address - Phone:512-869-1152
Practice Address - Fax:512-869-1145
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4265101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455585OtherVALUE OPTIONS PROVIDER #
TX8403BHOtherBCBS PROVIDER NUMBER