Provider Demographics
NPI:1518332642
Name:BOLES, MARGOT (MED, BCBA)
Entity type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:BOLES
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4126
Mailing Address - Country:US
Mailing Address - Phone:214-802-7946
Mailing Address - Fax:
Practice Address - Street 1:8031 FOREST TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4126
Practice Address - Country:US
Practice Address - Phone:214-802-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11314219103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst