Provider Demographics
NPI:1568132991
Name:BOLER & ASSOCIATES, COUNSELING & CONSULTATION SERVICES, LLC
Entity Type:Organization
Organization Name:BOLER & ASSOCIATES, COUNSELING & CONSULTATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:DE'ANDRE
Authorized Official - Last Name:BOLER
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, ALC, JSOCCP
Authorized Official - Phone:205-565-4469
Mailing Address - Street 1:126 ASHBY ST
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-5628
Mailing Address - Country:US
Mailing Address - Phone:205-565-4469
Mailing Address - Fax:205-637-4093
Practice Address - Street 1:126 ASHBY ST
Practice Address - Street 2:
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-5628
Practice Address - Country:US
Practice Address - Phone:205-565-4469
Practice Address - Fax:205-637-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL264723Medicaid