Provider Demographics
NPI:1780763045
Name:BOLLS, TOM N (LPC)
Entity type:Individual
Prefix:MR
First Name:TOM
Middle Name:N
Last Name:BOLLS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 HILLROCK DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3734
Mailing Address - Country:US
Mailing Address - Phone:512-468-7832
Mailing Address - Fax:512-328-3129
Practice Address - Street 1:504 W 17TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1203
Practice Address - Country:US
Practice Address - Phone:512-468-7832
Practice Address - Fax:512-328-3129
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional