Provider Demographics
NPI:1720849243
Name:CATHERINE L. BOLING, LLC
Entity Type:Organization
Organization Name:CATHERINE L. BOLING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BOLING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:417-239-5280
Mailing Address - Street 1:2280 W ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2206
Mailing Address - Country:US
Mailing Address - Phone:417-239-5280
Mailing Address - Fax:417-332-8680
Practice Address - Street 1:574 STATE HIGHWAY 248 STE 2
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7799
Practice Address - Country:US
Practice Address - Phone:417-239-1389
Practice Address - Fax:417-332-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1790949469Medicaid