Provider Demographics
NPI:1922368299
Name:BOLTER, HELAINE (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:HELAINE
Middle Name:
Last Name:BOLTER
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FERNBROOK LN N
Mailing Address - Street 2:#120
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5338
Mailing Address - Country:US
Mailing Address - Phone:763-559-7050
Mailing Address - Fax:763-559-7060
Practice Address - Street 1:3300 FERNBROOK LN N
Practice Address - Street 2:#120
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5338
Practice Address - Country:US
Practice Address - Phone:763-559-7050
Practice Address - Fax:763-559-7060
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3139103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling