Provider Demographics
NPI:1316284730
Name:BOLYARD, LORETTA LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:LYNN
Last Name:BOLYARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:209 S MONTANA ST STE B2
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1679
Mailing Address - Country:US
Mailing Address - Phone:406-646-2470
Mailing Address - Fax:406-299-3911
Practice Address - Street 1:84 OHIO STREET
Practice Address - Street 2:STE 1
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1806
Practice Address - Country:US
Practice Address - Phone:406-646-2470
Practice Address - Fax:406-299-3911
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical