Healthcare Provider Details

I. General information

NPI: 1427551860
Provider Name (Legal Business Name): BOLD HEARTS AND SOUND MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 09/12/2025
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S FRETZ DR STE 107
EDMOND OK
73003-5869
US

IV. Provider business mailing address

PO BOX 1992
EDMOND OK
73083-1992
US

V. Phone/Fax

Practice location:
  • Phone: 405-757-1777
  • Fax: 405-805-6351
Mailing address:
  • Phone: 405-757-1777
  • Fax: 405-805-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number5008
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number5008
License Number StateOK

VIII. Authorized Official

Name: ESTHER ABIGAIL BOLD
Title or Position: CEO
Credential: MA, LPC, LADC, CCTP
Phone: 405-757-1777