Provider Demographics
NPI:1396398574
Name:BOLDT, GAIL LOUISE (LPC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LOUISE
Last Name:BOLDT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:MASUCHIKA
Other - Last Name:BOLDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:BIGLER
Mailing Address - State:PA
Mailing Address - Zip Code:16825-0319
Mailing Address - Country:US
Mailing Address - Phone:814-342-5845
Mailing Address - Fax:
Practice Address - Street 1:1633 PHILIPSBURG BIGLER HWY
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-8112
Practice Address - Country:US
Practice Address - Phone:814-342-5845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health