Provider Demographics
NPI:1033456553
Name:BRIDGES, TANDRA RENEE (LPCIT)
Entity Type:Individual
Prefix:MS
First Name:TANDRA
Middle Name:RENEE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LPCIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1710
Mailing Address - Country:US
Mailing Address - Phone:414-313-7656
Mailing Address - Fax:
Practice Address - Street 1:2941 N 44TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1710
Practice Address - Country:US
Practice Address - Phone:414-313-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI835-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI835-226OtherPROFESSIONAL COUNSELOR TRAINING LIC