Provider Demographics
NPI:1275959322
Name:BOULDIN, KARI KAY
Entity Type:Individual
Prefix:MS
First Name:KARI
Middle Name:KAY
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KARI
Other - Middle Name:KAY
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:501 SHADY PINE WAY APT A2
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8906
Mailing Address - Country:US
Mailing Address - Phone:561-628-1223
Mailing Address - Fax:
Practice Address - Street 1:4445 PINE FOREST DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-4676
Practice Address - Country:US
Practice Address - Phone:561-214-9259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2852106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist