MEDICARE: BOLD LIVING COUNSELING 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1710459672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLD LIVING COUNSELING PLLC

Provider Business Mailing Address
First Line	:	371 NE GILMAN BLVD STE 160
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2901
Country	:	US
Telephone Number	:	425-495-4163
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 NW GILMAN BLVD STE 306
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2549
Country	:	US
Telephone Number	:	425-495-4163
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. MELINDA BROOKE JOHNSON
Credential	:	MA, LMFT, PMH-C
Telephone Number	:	425-495-4163

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	10/31/2024

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