Provider Demographics
NPI:1558465831
Name:BOLTE, JEANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:BOLTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-0195
Mailing Address - Country:US
Mailing Address - Phone:228-222-5203
Mailing Address - Fax:601-336-2662
Practice Address - Street 1:201 E SCENIC DR
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-4417
Practice Address - Country:US
Practice Address - Phone:282-225-2032
Practice Address - Fax:601-336-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS40011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist