Healthcare Provider Details

I. General information

NPI: 1598542086
Provider Name (Legal Business Name): BOLD EMPOWERED AND RESILIENT THERAPY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 S EASTERN AVE STE 150
HENDERSON NV
89052-5576
US

IV. Provider business mailing address

11500 S EASTERN AVE STE 150
HENDERSON NV
89052-5576
US

V. Phone/Fax

Practice location:
  • Phone: 760-856-0607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGIE TURCHETTI
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 760-856-0607