Provider Demographics
NPI:1013249192
Name:BOLTE, CHERYL SOOZI (MC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:SOOZI
Last Name:BOLTE
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14815 E LOOKOUT LEDGE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6408
Mailing Address - Country:US
Mailing Address - Phone:480-236-6682
Mailing Address - Fax:480-619-4150
Practice Address - Street 1:8035 N 85TH WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4321
Practice Address - Country:US
Practice Address - Phone:480-236-6682
Practice Address - Fax:480-619-4150
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10915101YA0400X
AZLPC 10982101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)