1801167937 NPI number — PROF. PAUL KEVIN BOLINSKEY PH.D.

Table of content: PROF. PAUL KEVIN BOLINSKEY PH.D. (NPI 1801167937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801167937 NPI number — PROF. PAUL KEVIN BOLINSKEY PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLINSKEY
Provider First Name:
PAUL
Provider Middle Name:
KEVIN
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801167937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 ALLENDALE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47802-4751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-299-1034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INDIANA STATE UNIVERSITY PSYCHOLOGY CLINIC
Provider Second Line Business Practice Location Address:
ROOT HALL
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47809-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-237-3317
Provider Business Practice Location Address Fax Number:
812-237-4378
Provider Enumeration Date:
01/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  20042565A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 20042565A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)