Provider Demographics
NPI:1902395361
Name:BOLT COUNSELING SERVICES
Entity Type:Organization
Organization Name:BOLT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARSS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:228-382-3138
Mailing Address - Street 1:1921 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2976
Mailing Address - Country:US
Mailing Address - Phone:282-382-3138
Mailing Address - Fax:228-382-3138
Practice Address - Street 1:1921 24TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2976
Practice Address - Country:US
Practice Address - Phone:228-382-3138
Practice Address - Fax:228-382-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty