Provider Demographics
NPI:1699752329
Name:BOLIN, BARBARA M (LCPC, LMFT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:M
Last Name:BOLIN
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 W. MARION AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535
Mailing Address - Country:US
Mailing Address - Phone:217-872-8800
Mailing Address - Fax:217-872-8700
Practice Address - Street 1:332 W MARION AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535-1018
Practice Address - Country:US
Practice Address - Phone:217-872-8800
Practice Address - Fax:217-872-8700
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional