Provider Demographics
NPI:1710751318
Name:BOLDEN, WILLIAM XANDER
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:XANDER
Last Name:BOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MARK LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-1828
Mailing Address - Country:US
Mailing Address - Phone:314-604-7570
Mailing Address - Fax:
Practice Address - Street 1:531 MARK LN
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-1828
Practice Address - Country:US
Practice Address - Phone:314-604-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool