Provider Demographics
NPI:1548664964
Name:BOLING, MELODY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ANN
Last Name:BOLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR # DC067.00
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65212-1000
Mailing Address - Country:US
Mailing Address - Phone:573-884-1236
Mailing Address - Fax:573-884-5936
Practice Address - Street 1:1 HOSPITAL DR # DC067.00
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-1000
Practice Address - Country:US
Practice Address - Phone:573-884-1236
Practice Address - Fax:573-884-5936
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0011362084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry