Provider Demographics
NPI:1053706457
Name:BOVE, MOLLY (MA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:BOVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3709 S CONKLIN RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9712
Mailing Address - Country:US
Mailing Address - Phone:509-951-2927
Mailing Address - Fax:509-922-2586
Practice Address - Street 1:1831 S BARKER RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:WA
Practice Address - Zip Code:99016-9762
Practice Address - Country:US
Practice Address - Phone:509-209-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60487878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health