Betina Lynn Bolin, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

2707 Browns LN
Jonesboro, AR 72401

Phone

(870) 972-4939

Fax

(870) 972-4911

NPI assigned

Dec 3, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Berthelot Counseling

  • Mental Health Counselor
  • Dexter, MO
  • NPI 1154541746
  NPD (past)
• Solid Rock Christian Counseling, Inc

  • Social Worker
  • Poplar Bluff, MO
  • NPI 1427341510
  NPD (past)
• Solid Rock Christian Counseling, Inc

  • Mental Health Counselor
  • Poplar Bluff, MO
  • NPI 1699836403
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1639407588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2707 BROWNS LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724017213",
            "telephone_number": "870-972-4939",
            "fax_number": "870-972-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2707 BROWNS LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-972-4939",
            "fax_number": "870-972-4911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 S Walnut St",
            "address_purpose": "LOCATION",
            "city": "Dexter",
            "state": "MO",
            "postal_code": "638412144",
            "country_code": "US",
            "telephone_number": "573-624-9383",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "212 S Walnut St",
            "address_purpose": "LOCATION",
            "city": "Dexter",
            "state": "MO",
            "postal_code": "638412144",
            "country_code": "US",
            "telephone_number": "573-624-9383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLIN",
        "first_name": "BETINA",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-12-03",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2002009971",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CMS",
            "identifier": "1639407588",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639407588",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK, INC",
            "identifier": "1639407588",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "1639407588",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Bokker
• Phillip C Bokker
• Charles Alan Bolden
• Marsha A Bolden
• Kristina Bolick
• Jana Bolin
• Stephanie Bolin, OTD
• Ashley Boling, PTA
• Baleigh Boling
• Jodi Shannon Boling, D.D.S.

• Clinical Social Worker in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.