Provider Demographics
NPI:1740933910
Name:BOLTHOUSE, GARRET MICHAEL (MA, MCFC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:GARRET
Middle Name:MICHAEL
Last Name:BOLTHOUSE
Suffix:
Gender:M
Credentials:MA, MCFC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91638
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85752-1638
Mailing Address - Country:US
Mailing Address - Phone:520-275-3506
Mailing Address - Fax:
Practice Address - Street 1:2295 W MAGEE RD UNIT 105
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-4316
Practice Address - Country:US
Practice Address - Phone:520-257-1168
Practice Address - Fax:520-306-4861
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23548101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor