Provider Demographics
NPI:1619476413
Name:BOLING, KARLYN ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARLYN
Middle Name:ELIZABETH
Last Name:BOLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KARLYN
Other - Middle Name:ELIZABETH
Other - Last Name:VATTHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4425 LAKE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-5637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging