Organization
BOLT BEHAVIOR SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI ANN BOLT BCBA (OWNER)
(386) 846-8407
Entity
Organization
Contact information
Practice address
1747 MANDARIN ESTATES DR, JACKSONVILLE, FL 32223-5549
(386) 846-8407
(904) 770-4882
Mailing address
1747 MANDARIN ESTATES DR, JACKSONVILLE, FL 32223-5549
(386) 846-8407
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017607800
—
FL
05
—
106830500
—
FL
Enumeration date
01/30/2017
Last updated
05/19/2025
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