Organization
JEANNETTE BOLTE, PH.D, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEANNETTE BOLTE PH.D (OWNER/PROVIDER)
(288) 596-5407
Entity
Organization
Contact information
Practice address
8933C LORRAINE RD, GULFPORT, MS 39503-4176
(228) 897-7730
(228) 575-0886
Mailing address
8933C LORRAINE RD, GULFPORT, MS 39503-4176
(228) 897-7730
(228) 575-0886
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03501391
—
MS
Enumeration date
05/13/2019
Last updated
01/16/2021
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