Provider Demographics
NPI:1518711498
Name:BOLINGER, CALLANN LANE (SUPERVISED MFT)
Entity Type:Individual
Prefix:MRS
First Name:CALLANN
Middle Name:LANE
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:SUPERVISED MFT
Other - Prefix:
Other - First Name:CALI
Other - Middle Name:
Other - Last Name:BOLINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:718 THOMPSON LN STE 108-301
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3600
Mailing Address - Country:US
Mailing Address - Phone:615-924-5457
Mailing Address - Fax:
Practice Address - Street 1:1226 LAKEVIEW DR STE G
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-3090
Practice Address - Country:US
Practice Address - Phone:615-669-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist