Provider Demographics
NPI:1255533329
Name:BOLTHOUSE, ELIZABETH LORENE (MA MS LPC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LORENE
Last Name:BOLTHOUSE
Suffix:
Gender:F
Credentials:MA MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 HENRY ST
Mailing Address - Street 2:PMB 223
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-740-8774
Mailing Address - Fax:
Practice Address - Street 1:794 PINE ST STE 220K
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-1020
Practice Address - Country:US
Practice Address - Phone:231-740-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional