Provider Demographics
NPI:1932117348
Name:BOLLINGER, HAUTINA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:HAUTINA
Middle Name:K
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1569
Mailing Address - Country:US
Mailing Address - Phone:214-356-4329
Mailing Address - Fax:972-691-2342
Practice Address - Street 1:3861 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1569
Practice Address - Country:US
Practice Address - Phone:214-356-4329
Practice Address - Fax:972-691-2342
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25332103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113407402Medicaid
TX113407402Medicaid