Provider Demographics
NPI:1962223099
Name:BOLD MINDSET PLLC
Entity type:Organization
Organization Name:BOLD MINDSET PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORREX
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:352-281-1151
Mailing Address - Street 1:105 FLAGSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-6831
Mailing Address - Country:US
Mailing Address - Phone:352-281-1151
Mailing Address - Fax:
Practice Address - Street 1:105 FLAGSTONE CT
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-6831
Practice Address - Country:US
Practice Address - Phone:352-281-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty