Provider Demographics
NPI:1396125514
Name:LISA BOLHOUSE
Entity type:Organization
Organization Name:LISA BOLHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRIVATE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOLHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-443-8977
Mailing Address - Street 1:4996 BRANDED OAKS CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-8834
Mailing Address - Country:US
Mailing Address - Phone:850-443-8977
Mailing Address - Fax:850-765-5487
Practice Address - Street 1:109 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6152
Practice Address - Country:US
Practice Address - Phone:850-443-8977
Practice Address - Fax:850-765-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW1872251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health