Provider Demographics
NPI:1215331624
Name:BOLTON, ALAN (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:BOLTON
Suffix:
Gender:M
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 MIAMI HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-1813
Mailing Address - Country:US
Mailing Address - Phone:513-791-8775
Mailing Address - Fax:
Practice Address - Street 1:8916 FONTAINEBLEAU TER
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-4806
Practice Address - Country:US
Practice Address - Phone:513-931-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist