Provider Demographics
NPI:1033509278
Name:BRIDGE OF HOPE COUNSELING
Entity Type:Organization
Organization Name:BRIDGE OF HOPE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLIENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAVENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-209-7049
Mailing Address - Street 1:1736 E CHARLESTON BLVD
Mailing Address - Street 2:#46
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-7900
Mailing Address - Country:US
Mailing Address - Phone:702-209-7049
Mailing Address - Fax:
Practice Address - Street 1:1736 E CHARLESTON BLVD
Practice Address - Street 2:#46
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-7900
Practice Address - Country:US
Practice Address - Phone:702-209-7049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1902198559OtherNPI