Provider Demographics
NPI:1295118354
Name:BOLIOU, PATRICIA (LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BOLIOU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 S FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1306
Mailing Address - Country:US
Mailing Address - Phone:208-375-7777
Mailing Address - Fax:208-375-7598
Practice Address - Street 1:1327 S FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1306
Practice Address - Country:US
Practice Address - Phone:208-375-7777
Practice Address - Fax:208-375-7598
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5901101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health