Basic Information
| Provider Information | |||||||||
| NPI: | 1194343707 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRIDGES CONSULTATION AND TREATMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | W4874 EDELWEISS ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW GLARUS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084389360 | ||||||||
| FaxNumber: | 7159728113 | ||||||||
| Practice Location | |||||||||
| Address1: | W4874 EDELWEISS ROAD | ||||||||
| Address2: | |||||||||
| City: | NEW GLARUS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6084389360 | ||||||||
| FaxNumber: | 7159728113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2020 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | SENF | ||||||||
| AuthorizedOfficialFirstName: | KASSITY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER, BCBA | ||||||||
| AuthorizedOfficialTelephone: | 6084389360 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.