Provider Demographics
NPI:1992587182
Name:BOLDEN, NYELA SIMONE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:NYELA
Middle Name:SIMONE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:NYELA
Other - Middle Name:SIMONE
Other - Last Name:HOOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:2827 LELIA ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6821
Mailing Address - Country:US
Mailing Address - Phone:832-228-5160
Mailing Address - Fax:
Practice Address - Street 1:2827 LELIA ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6821
Practice Address - Country:US
Practice Address - Phone:832-228-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical