Healthcare Provider Details

I. General information

NPI: 1376497073
Provider Name (Legal Business Name): BOLD MIND THERAPY A LICENSED PROFESSIONAL CLINICAL COUNSELOR CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 CUESTA DR # B3320
MOUNTAIN VIEW CA
94040-3667
US

IV. Provider business mailing address

809 CUESTA DR # B3320
MOUNTAIN VIEW CA
94040-3667
US

V. Phone/Fax

Practice location:
  • Phone: 650-316-0328
  • Fax:
Mailing address:
  • Phone: 650-316-0328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA ROMERO
Title or Position: PSYCHOTHERAPIST, OWNER
Credential: LPCC, LPC
Phone: 650-316-0328