Individual
DR. BRIAN KEITH BOLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY. D., L.M.H.C.
Contact information
Practice address
3903 NORTHDALE BLVD STE 100-47, TAMPA, FL 33624-1864
(813) 817-8498
(813) 406-5158
Mailing address
4651 WANDERING WAY, WESLEY CHAPEL, FL 33544-8500
(813) 907-0285
(813) 406-5158
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAP 2482
FL
101YM0800X
Mental Health Counselor
Primary
MH 8545
FL
101YM0800X
Mental Health Counselor
MH8545
FL
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
10/26/2009
Last updated
11/19/2024
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