Provider Demographics
NPI:1811416647
Name:TEAFORD-BOLDRIDGE, REBECCA (LMAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TEAFORD-BOLDRIDGE
Suffix:
Gender:F
Credentials:LMAC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BOLDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E LAHARPE ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4520
Mailing Address - Country:US
Mailing Address - Phone:660-665-1962
Mailing Address - Fax:660-665-3989
Practice Address - Street 1:1009 E OLD HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-4969
Practice Address - Country:US
Practice Address - Phone:913-764-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)