Provider Demographics
NPI:1811756752
Name:BOLES, MARISSA LINN (TLMHC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LINN
Last Name:BOLES
Suffix:
Gender:F
Credentials:TLMHC
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 130
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:IA
Mailing Address - Zip Code:52358-0130
Mailing Address - Country:US
Mailing Address - Phone:319-643-2532
Mailing Address - Fax:319-643-5708
Practice Address - Street 1:233 S 2ND ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:IA
Practice Address - Zip Code:52358-9620
Practice Address - Country:US
Practice Address - Phone:319-643-2532
Practice Address - Fax:319-643-5708
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA124599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health