MEDICARE: JESSICA BOLDEN PSYCHOTHERAPY GROUP, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1184570293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESSICA BOLDEN PSYCHOTHERAPY GROUP, PLLC

Provider Business Mailing Address
First Line	:	149 ELLIS SPRING DR
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76085-1634
Country	:	US
Telephone Number	:	432-664-2261
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 OLD ANNETTA RD
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-4455
Country	:	US
Telephone Number	:	817-887-8157
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA RENEE RILEY-BOLDEN
Credential	:	MA, LPC-S
Telephone Number	:	432-664-2261

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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