Charissa Dawn Boldridge, TLMLP
Individual provider Active NPI Clinical Psychologist · Emporia, KS
NPI 1578800199 · NPPES record last updated Jan 16, 2013
Key facts
- NPI
- 1578800199
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2433 (KS)
- Practice address
- 618 Commercial St
Emporia, KS 66801-3969 - Phone
- (620) 343-7746
- Fax
- (620) 342-0745
- NPI assigned
- Jan 16, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2433 | KS | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2433 | KS | Yes |
Addresses
Primary practice location
618 Commercial St
Emporia, KS 66801-3969
Mailing address
618 Commercial St
Emporia, KS 66801-3969
Phone (620) 343-7746
Other providers in Emporia, KS
- Melinda Bishop Erwin
- Bradon Bitter
- Johanna Black
- Tamara Lynn Black
- Steven Blocker
- Bombadil Behavioral Health LLC
- Joseph Edward Bosiljevac Jr.
- Regan Sue Ann Botkin
- Brady Optical
- James W Brady
All providers in Emporia, KS · Clinical Psychologist in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.