Provider Demographics
NPI:1952342008
Name:BOLTE, BETTY (LCP, LCAC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:BOLTE
Suffix:
Gender:F
Credentials:LCP, LCAC
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:GAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMLP
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66505-0747
Mailing Address - Country:US
Mailing Address - Phone:785-587-4300
Mailing Address - Fax:785-587-4377
Practice Address - Street 1:814 CAROLINE AVE
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-5210
Practice Address - Country:US
Practice Address - Phone:785-762-5250
Practice Address - Fax:785-762-2144
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS476101YA0400X
KS0517103T00000X
KS904103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
11658758OtherCAQH
KS856659OtherBCBS
KS200440980AMedicaid