Provider Information for 1427357615
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Mr. KEVIN LEE BOLTON MT-BC, LPC, MHSP
Sex: Male
NPI: 1427357615
Last Updated: 2024-03-08
Certification Date: 2024-03-08
Certification Date: 2024-03-08
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1427357615 | ||||||||||||||||
| Enumeration Date | 2011-03-28 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 745 S CHURCH ST STE 805 MURFREESBORO, TN 37130-4983 United States Phone: 615-624-4481 | Fax: | ||||||||||||||||
| Primary Practice Address | 745 S CHURCH ST STE 805 MURFREESBORO, TN 37130-4983 United States Phone: 615-624-4481 | Fax: | ||||||||||||||||
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