# JEANNETTE BOLTE, PH.D, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598321721
- **Authorized official:** DR. JEANNETTE BOLTE PH.D (OWNER/PROVIDER)
- **Authorized official phone:** (288) 596-5407

## Contact information

- **Practice address:** 8933C LORRAINE RD, GULFPORT, MS 39503-4176
- **Practice address phone:** (228) 897-7730
- **Practice address fax:** (228) 575-0886
- **Mailing address:** 8933C LORRAINE RD, GULFPORT, MS 39503-4176
- **Mailing address phone:** (228) 897-7730
- **Mailing address fax:** (228) 575-0886

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/13/2019
- **Last updated:** 01/16/2021