Individual
DR. KATHERINE L BOLYARD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
911 N 18TH ST, STE 1, LAFAYETTE, IN 47904-2288
(765) 447-7146
(765) 447-4932
Mailing address
911 N 18TH ST, STE 1, LAFAYETTE, IN 47904-2288
(765) 447-7146
(765) 447-4932
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041188A
IN
103TA0700X
Adult Development & Aging Psychologist
20041188A
IN
103TC1900X
Counseling Psychologist
20041188A
IN
103TP2701X
Group Psychotherapy Psychologist
20041188A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200186570A
—
IN
Enumeration date
06/18/2006
Last updated
12/16/2019
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