Bolyard, Russell L

Bolyard, Russell L is an sole proprietor health care provider with primary practice located at 1282 Union Ave Health South Rehabilitation Hospital, Memphis TN 38104-3414. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Bolyard, Russell L can be contacted via phone (901) 729-5159.

Contact Information

Primary practice address
1282 Union Ave Health South Rehabilitation Hospital Memphis TN 38104-3414
Phone: (901) 729-5159
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X P00907 Tennessee

Profile Details

NPI number 1073562997
LBN Legal business name Bolyard, Russell L
Credentials PSY.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 8th, 2006
Last updated Apr 26th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073562997 NPPES
Mississippi MEDICAID 00951505
Mississippi Other 3100399
Mississippi MEDICAID 3689428

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