1609141860 NPI number — THE BRIDGE YOUTH AND FAMILY COUNSELING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609141860 NPI number — THE BRIDGE YOUTH AND FAMILY COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BRIDGE YOUTH AND FAMILY COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609141860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1494
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77545-1494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-536-5475
Provider Business Mailing Address Fax Number:
281-972-9328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14002 GARDEN BROOK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSHARON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77583-2066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-536-5475
Provider Business Practice Location Address Fax Number:
281-972-9328
Provider Enumeration Date:
03/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
SHERRIE
Authorized Official Middle Name:
COOK
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
281-536-5475

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  61830 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 00112953 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TX , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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