Provider Demographics
NPI:1487206470
Name:BOLD, LASHAUNN (LCSW)
Entity Type:Individual
Prefix:
First Name:LASHAUNN
Middle Name:
Last Name:BOLD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 LYNDA LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3826
Mailing Address - Country:US
Mailing Address - Phone:817-271-8285
Mailing Address - Fax:
Practice Address - Street 1:1615 W ABRAM ST STE H
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-1788
Practice Address - Country:US
Practice Address - Phone:817-271-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health