Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 20041188A | IN |
Y | 103T00000X | Psychologist | 20041188A | IN |
N | 103TA0700X | Adult Development & Aging Psychologist | 20041188A | IN |
N | 103TC1900X | Counseling Psychologist | 20041188A | IN |
N | 103TP2701X | Group Psychotherapist | 20041188A | IN |
NPI | 1689619215 |
---|---|
Provider Name | Dr. Katherine L Bolyard |
First Address | Lafayette, IN 47904-2288 |
Second Address | Lafayette, IN 47904-2288 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 16/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200186570A | (05) | IN |