Individual
RUSSELL L BOLYARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1282 UNION AVE, HEALTH SOUTH REHABILITATION HOSPITAL, MEMPHIS, TN 38104-3414
(901) 729-5159
Mailing address
9477 CEDAR GLEN CV, CORDOVA, TN 38016-4700
(901) 729-5159
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
P00907
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00951505
—
MS
01
—
3100399
BCBS OF TN
TN
05
—
3689428
—
TN
Enumeration date
05/08/2006
Last updated
04/26/2012
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