Provider Demographics
NPI:1790949469
Name:BOLING, CATHERINE LEA (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LEA
Last Name:BOLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 STATE HIGHWAY 248
Mailing Address - Street 2:STE 2
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7740
Mailing Address - Country:US
Mailing Address - Phone:417-239-1389
Mailing Address - Fax:417-332-8680
Practice Address - Street 1:574 STATE HIGHWAY 248
Practice Address - Street 2:STE 2
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7740
Practice Address - Country:US
Practice Address - Phone:417-239-1389
Practice Address - Fax:417-332-8680
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0017571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1346412327Medicaid