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General NPI Number Information
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NPI Number | 1902395361
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Entity Type | Organization
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Legal Business Name | BOLT COUNSELING SERVICES
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 1921 24TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2976
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Country | US
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Telephone | 228-382-3138
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Fax | 228-382-3138
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Provider Business Mailing Address
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Address Line | 1921 24TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2976
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Country | US
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Telephone | 282-382-3138
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Fax | 228-382-3138
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Authorized Official
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Title or Position | OWNER, COUNSELOR
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Name | MR. CASEY BEARSS
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Credential | LPC
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Telephone | 228-382-3138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2229
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License Number State | MS
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