Provider Demographics
NPI:1770013047
Name:BOLO, LEANUE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LEANUE
Middle Name:
Last Name:BOLO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 GLENSPRINGS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2351
Mailing Address - Country:US
Mailing Address - Phone:513-825-6600
Mailing Address - Fax:513-825-6696
Practice Address - Street 1:375 GLENSPRINGS DR STE 300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2351
Practice Address - Country:US
Practice Address - Phone:513-825-6600
Practice Address - Fax:513-825-6696
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1700297101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health