Provider Demographics
NPI:1649578295
Name:BOLTON COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:BOLTON COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCMH
Authorized Official - Phone:605-484-1632
Mailing Address - Street 1:PO BOX 9051
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-9051
Mailing Address - Country:US
Mailing Address - Phone:605-484-1632
Mailing Address - Fax:605-718-8718
Practice Address - Street 1:13594 CHARIOT PL
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-7105
Practice Address - Country:US
Practice Address - Phone:605-484-1632
Practice Address - Fax:605-718-8718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty