Kevin R. Bolt, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

80934 Issued in TX

Practice address

300 E 6TH St
Texarkana, AR 71854-5207

Phone

(870) 772-0156

NPI assigned

Dec 7, 2022

Last updated

Dec 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Supportive Care LLCGroup PAC ID 7719126655, 67 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Supportive Care LLC

  • Clinical Psychologist
  • Garland, TX
  • NPI 1477895043
  Medicare reassignment Care Compare group NPD
• Rayl Enterprises

  dba Grace Counseling Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fort Worth, TX
  • NPI 1891044228

  Counselor

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1326759648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 FM 995",
            "city": "ATLANTA",
            "state": "TX",
            "postal_code": "755516412",
            "telephone_number": "903-733-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E 6TH ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718545207",
            "telephone_number": "870-772-0156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLT",
        "first_name": "KEVIN",
        "middle_name": "R.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-07",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "TX",
            "license": "80934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Ella Billingsley
• Jessica Bishop
• Brent Blackburn, MD
• Jean-Michael Blanc, DO
• Dennis Michael Blankenship, M.D.
• Courtney Bone
• Border City Chiropractic
• Pamela Brackman, RN
• Christal Ann Bradford, MHPP
• Bradley Bibb MD PLLC

• Counselor in Texarkana, AR
• Providers in Texarkana, AR by specialty
• Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.