Provider Demographics
NPI:1629217120
Name:BOLLE, PATRICIA DEANNE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DEANNE
Last Name:BOLLE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE 172
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6172
Mailing Address - Country:US
Mailing Address - Phone:817-586-8352
Mailing Address - Fax:
Practice Address - Street 1:515 W SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 172
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6172
Practice Address - Country:US
Practice Address - Phone:817-586-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional