Bolt Behavior Services

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

BOLT BEHAVIOR SERVICES

Practice address

1747 Mandarin Estates Dr
Jacksonville, FL 32223-5549

Phone

(386) 846-8407

Fax

(904) 770-4882

NPI assigned

Jan 30, 2017

Organization subpart

No

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

Authorized official

Name

Lori Ann Bolt, BCBANPI 1346527793

Title

Owner

Phone

(386) 846-8407

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lori Ann Bolt, BCBA

  • Behavior Analyst
  • St Augustine, FL
  • NPI 1346527793
  NPD Authorized official
• Peyton Lightning Bolt

  • Behavior Analyst
  • Saint Johns, FL
  • NPI 1104331768
  NPD (past)

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747612800000",
    "number": "1568909497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 MANDARIN ESTATES DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322235549",
            "telephone_number": "386-846-8407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 MANDARIN ESTATES DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322235549",
            "telephone_number": "386-846-8407",
            "fax_number": "904-770-4882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLT BEHAVIOR SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-30",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A",
        "authorized_official_last_name": "BOLT",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-846-8407",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106830500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "017607800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valdora L Bollenback, D.P.T.
• James Bolling, MD
• Jasmine R Bolling
• Justin Tyler Bollingmo, LMFT
• Emma Boloutchi
• Kimberly J Bolton
• Mydris Boltze
• James C Boman, MD
• James Stanley Bomhard, MD
• Pranav Reddy Bommineni, DO

• All providers in Jacksonville, FL
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.