Provider Demographics
NPI:1841189016
Name:BOLLIG, PHILIP A (LMSW)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:BOLLIG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:KS
Mailing Address - Zip Code:67144-0424
Mailing Address - Country:US
Mailing Address - Phone:707-631-2799
Mailing Address - Fax:
Practice Address - Street 1:6611 E CENTRAL AVE STE C
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1937
Practice Address - Country:US
Practice Address - Phone:316-650-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14136104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker