Provider Demographics
NPI:1023354057
Name:SUSAN G. BOLEY, PH.D. P.C.
Entity type:Organization
Organization Name:SUSAN G. BOLEY, PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:303-794-7761
Mailing Address - Street 1:11 W DRY CREEK CIR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8077
Mailing Address - Country:US
Mailing Address - Phone:303-794-7761
Mailing Address - Fax:
Practice Address - Street 1:11 W DRY CREEK CIR
Practice Address - Street 2:SUITE 140
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8077
Practice Address - Country:US
Practice Address - Phone:303-794-7761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2224103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty