Provider Demographics
NPI:1770247595
Name:BOLT, HOLLY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:BOLT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 E CRESTLINE CIR STE 145
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3656
Mailing Address - Country:US
Mailing Address - Phone:720-706-1944
Mailing Address - Fax:
Practice Address - Street 1:7400 E CRESTLINE CIR STE 145
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3656
Practice Address - Country:US
Practice Address - Phone:720-706-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician