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General NPI Number Information
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NPI Number | 1376497073
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Entity Type | Organization
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Legal Business Name | BOLD MIND THERAPY A LICENSED PROFESSIONAL CLINICAL COUNSELOR CO
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Dates
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Enumeration Date | 02/21/2026
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Last Update Date | 02/21/2026
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Provider Practice Location Address
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Address Line | 809 CUESTA DR # B3320
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3667
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Country | US
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Telephone | 650-316-0328
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Fax |
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Provider Business Mailing Address
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Address Line | 809 CUESTA DR # B3320
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3667
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Country | US
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Telephone | 650-316-0328
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST, OWNER
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Name | LISA ROMERO
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Credential | LPCC, LPC
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Telephone | 650-316-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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