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Burt Bolt, LCPC

Counselor, Professional in Moline, IL. Individual provider (NPI-1).

NPI number1649382706
StatusActive
Last updated in NPPESDec 6, 2007

Details

NPI
1649382706
Entity type
Individual (NPI-1)
Name
Burt Bolt
Credential
LCPC
Sex
Male
Sole proprietor
No
Enumeration date
Aug 31, 2006
Last updated
Dec 6, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YP2500X Counselor, Professional180-005984ILYes

Practice location

2100 52nd Ave
Moline, IL 61265-6366

Phone 309-797-2900 · Fax 309-797-2147

Mailing address

2100 52nd Ave
Moline, IL 61265-6366

Phone 309-797-2900 · Fax 309-797-2147

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