Provider Demographics
NPI:1184795775
Name:BOLIN, EDWARD P (PSYD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:BOLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FOREST CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5078
Mailing Address - Country:US
Mailing Address - Phone:865-588-9919
Mailing Address - Fax:865-909-0422
Practice Address - Street 1:111 FOREST CT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5078
Practice Address - Country:US
Practice Address - Phone:865-588-9919
Practice Address - Fax:865-909-0422
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN049886OtherBCBS
TN3682563Medicare ID - Type UnspecifiedMEDICARE