| Jeannette Bolte, Ph.d, Pllc | |
|
8933c Lorraine Rd Gulfport MS 39503-4176 | |
| (228) 897-7730 | |
| (228) 575-0886 |
| Full Name | Jeannette Bolte, Ph.d, Pllc |
|---|---|
| Speciality | Clinic/center |
| Location | 8933c Lorraine Rd, Gulfport, Mississippi |
| Authorized Official Name and Position | Jeannette Bolte (OWNER/PROVIDER) |
| Authorized Official Contact | 2885965407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeannette Bolte, Ph.d, Pllc 8933c Lorraine Rd Gulfport MS 39503-4176 Ph: (228) 897-7730 | Jeannette Bolte, Ph.d, Pllc 8933c Lorraine Rd Gulfport MS 39503-4176 Ph: (228) 897-7730 |
| NPI Number | 1598321721 |
|---|---|
| Provider Enumeration Date | 05/13/2019 |
| Last Update Date | 01/16/2021 |
| Certification Date | 01/16/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598321721 | NPI | - | NPPES |
| 03501391 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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