| Entity Name: | BOLT BEHAVIOR SERVICES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Feb 2016 (9 years ago) |
| Document Number: | L16000029491 |
| FEI/EIN Number | 81-1457129 |
| Address: | 1747 Mandarin Estates Drive, jacksonville, FL, 32223, US |
| Mail Address: | 1747 Mandarin Estates Drive, jacksonville, FL, 32223, US |
| ZIP code: | 32223 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568909497 | 2017-01-30 | 2017-01-30 | 741 AUSTIN PL, SAINT JOHNS, FL, 322595472, US | 741 AUSTIN PL, SAINT JOHNS, FL, 322595472, US | |||||||||||||||||||||
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| Phone | +1 386-846-8407 |
| Fax | 9047704882 |
Authorized person
| Name | MS. LORI ANN BOLT |
| Role | SENIOR BEHAVIOR ANALYST |
| Phone | 3868468407 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017607800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Bolt Lori A | Agent | 1747 Mandarin Estates Drive, jacksonville, FL, 32223 |
| Name | Role | Address |
|---|---|---|
| BOLT LORI | President | 1747 Mandarin Estates Drive, jacksonville, FL, 32223 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-20 | 1747 Mandarin Estates Drive, jacksonville, FL 32223 | No data |
| CHANGE OF MAILING ADDRESS | 2020-04-20 | 1747 Mandarin Estates Drive, jacksonville, FL 32223 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-04-20 | 1747 Mandarin Estates Drive, jacksonville, FL 32223 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-03-01 | Bolt, Lori Ann | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-19 |
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-01-17 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-03-23 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-03-01 |
| Florida Limited Liability | 2016-02-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
