Individual
JEFFREY TYLER BOLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, BCBA, LBA
Contact information
Practice address
7902 BEULAH CHURCH RD UNIT 103, LOUISVILLE, KY 40228-2709
(023) 788-3115
Mailing address
1074 MEADE SPRINGS RD, BRANDENBURG, KY 40108-8376
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
163604
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-18435
BCBA CERTIFICATE
KY
01
—
163604
KENTUCKY LBA
KY
Enumeration date
03/17/2015
Last updated
07/02/2025
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