Provider Demographics
NPI:1194497123
Name:BOLIN, EMMALEE ESTHER (LBSW, CADC)
Entity type:Individual
Prefix:
First Name:EMMALEE
Middle Name:ESTHER
Last Name:BOLIN
Suffix:
Gender:F
Credentials:LBSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:IA
Mailing Address - Zip Code:51463-7700
Mailing Address - Country:US
Mailing Address - Phone:712-267-1031
Mailing Address - Fax:
Practice Address - Street 1:1550 6TH ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455-1004
Practice Address - Country:US
Practice Address - Phone:712-655-8353
Practice Address - Fax:712-655-8241
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)