Most Relevant Information
Provider Data
| NPI Number: | 1003368457 |
| Provider Name: | SHANE BOLTON |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/02/2016 |
| Last Updated: | 11/02/2016 |
Provider Practice Location
1450 PETERMAN DR STE A
ALEXANDRIA
LA
713013432
Practice Location Phone/Fax
| Phone: | 3184734328 |
| Fax: |
Provider Mailing Location
1450 PETERMAN DR STE A
ALEXANDRIA
LA
713013432
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |