Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 24123 | TX |
NPI | 1013028299 |
---|---|
Provider Name | Dr. Deborah Sue Boelter |
First Address | Dallas, TX 75248 |
Second Address | Dallas, TX 75248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |