Provider Demographics
NPI:1558909044
Name:BOLLATO, MARY MARGARET (LPC - INTERN)
Entity Type:Individual
Prefix:
First Name:MARY MARGARET
Middle Name:
Last Name:BOLLATO
Suffix:
Gender:F
Credentials:LPC - INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25511 BUDDE RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2080
Mailing Address - Country:US
Mailing Address - Phone:281-748-0233
Mailing Address - Fax:281-715-4742
Practice Address - Street 1:25511 BUDDE RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2080
Practice Address - Country:US
Practice Address - Phone:281-748-0233
Practice Address - Fax:281-715-4742
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-15
Last Update Date:2019-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health