Provider Demographics
NPI:1770885014
Name:CHRIS BOLING LLC
Entity type:Organization
Organization Name:CHRIS BOLING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-593-0830
Mailing Address - Street 1:234 RUE BEAUREGARD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3285
Mailing Address - Country:US
Mailing Address - Phone:337-593-0830
Mailing Address - Fax:337-593-0122
Practice Address - Street 1:234 RUE BEAUREGARD
Practice Address - Street 2:STE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3285
Practice Address - Country:US
Practice Address - Phone:337-593-0830
Practice Address - Fax:337-593-0122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRIS BOLING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-18
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty