Basic Information
| Provider Information | |||||||||
| NPI: | 1295118354 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLIOU | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1327 S FIVE MILE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837091306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083757777 | ||||||||
| FaxNumber: | 2083757598 | ||||||||
| Practice Location | |||||||||
| Address1: | 1327 S FIVE MILE RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837091306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083757777 | ||||||||
| FaxNumber: | 2083757598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LPC-5901 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.