MEDICARE: BOLD SPIRIT COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	2084P0804X	Child & Adolescent Psychiatry Physician
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1790423218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLD SPIRIT COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	3323 DRY CREEK DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3784
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3323 DRY CREEK DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-3784
Country	:	US
Telephone Number	:	517-292-0314
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	SARA SHARAF BEG
Credential	:	LPC
Telephone Number	:	551-580-4053

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	05/17/2024

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