Provider Demographics
NPI:1710459672
Name:BOLD LIVING COUNSELING PLLC
Entity Type:Organization
Organization Name:BOLD LIVING COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, PMH-C
Authorized Official - Phone:425-495-4163
Mailing Address - Street 1:160 NW GILMAN BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2549
Mailing Address - Country:US
Mailing Address - Phone:425-495-4163
Mailing Address - Fax:
Practice Address - Street 1:160 NW GILMAN BLVD STE 306
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2549
Practice Address - Country:US
Practice Address - Phone:425-495-4163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty