Provider Demographics
NPI:1407229966
Name:BOLTE, SPENSER
Entity Type:Individual
Prefix:
First Name:SPENSER
Middle Name:
Last Name:BOLTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 N WOODED HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5415
Mailing Address - Country:US
Mailing Address - Phone:870-577-9392
Mailing Address - Fax:
Practice Address - Street 1:907 S DETROIT AVE
Practice Address - Street 2:SUITE 1140
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-4205
Practice Address - Country:US
Practice Address - Phone:870-577-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist