Provider Demographics
NPI:1053442202
Name:HOWELL, BRIDGET KATHLEEN (EDS, NCSP, LPC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:KATHLEEN
Last Name:HOWELL
Suffix:
Gender:F
Credentials:EDS, NCSP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 W GREGG DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1719
Mailing Address - Country:US
Mailing Address - Phone:602-315-7176
Mailing Address - Fax:480-507-1356
Practice Address - Street 1:140 SOUTH GILBERT ROAD
Practice Address - Street 2:GILBERT PUBLIC SCHOOLS
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296
Practice Address - Country:US
Practice Address - Phone:480-813-1770
Practice Address - Fax:480-507-1356
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0643101Y00000X
AZ15698103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ586357Medicaid
AZ586357Medicaid