Russell L Bolyard in Cordova - Psychologist
Russell L Bolyard - NPI 1073562997
Russell L Bolyard is a Psychologist in Cordova, Tennessee. Russell L Bolyard practices all healthcare services and medical treatments related to Psychologist. The NPI Number for Russell L Bolyard is 1073562997. The last update date is 2012-04-26.
Russell L Bolyard's current location address is 9477 Cedar Glen Cv, Cordova, Tennessee. You can contact this provider via phone number 9017295159. The mailing address for Russell L Bolyard is 9477 Cedar Glen Cv, Cordova, Tennessee. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Russell L Bolyard |
|---|---|
| Address | 9477 Cedar Glen Cv, Cordova, Tennessee |
| Phone Number | 9017295159 |
| Fax Number | |
| Sole Proprietor | Y |
| Credentials | PSY.D. |
NPI Number Detail
| NPI Number | 1073562997 |
|---|---|
| Provider Enumeration Date | 2006-05-08 |
| Last Updated Date | 2012-04-26 |
Provider Mailing Address Detail
| Address | 9477 Cedar Glen Cv |
|---|---|
| City | Cordova |
| State | Tennessee (TN) |
| Post Code | 380164700 |
| Phone Number | 9017295159 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Psychologist |
|---|---|
| Taxonomy | 103T00000X |
| Licence No | P00907 |
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Definition: A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and proce |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 951505 | MS | -- | |
| 3100399 | TN | BCBS OF TN | |
| 3689428 | TN | -- |
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What is the unique identification code assigned to Russell L Bolyard by the Centers for Medicare & Medicaid Services?
The Russell L Bolyard has been issued the NPI (National Provider Identifier) 1073562997. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Russell L Bolyard?
The Russell L Bolyard is situated at 9477 Cedar Glen Cv, in the city of Cordova, state of TN, with the zip code 380164700.
What is the Russell L Bolyard's specialty and taxonomy code?
The Russell L Bolyard's specialty is Psychologist, and the corresponding taxonomy code is 103T00000X.
On what date did the Centers for Medicare & Medicaid Services issue the 1073562997 to Russell L Bolyard?
The Russell L Bolyard received its 1073562997 assignment from the Centers for Medicare & Medicaid Services on 2006-05-08.
When was the information regarding Russell L Bolyard, such as address, specialty, and other details, most recently verified or confirmed to be accurate?
The information pertaining to Russell L Bolyard, including its address, specialty, and other relevant details, was most recently verified or confirmed to be accurate on 2012-04-26.