Provider Demographics
NPI:1093593378
Name:INTERFAITH BRIDGE COUNSELING, PLLC
Entity Type:Organization
Organization Name:INTERFAITH BRIDGE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:HILDER
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-229-7022
Mailing Address - Street 1:7432 E BATES DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-6013
Mailing Address - Country:US
Mailing Address - Phone:480-229-7022
Mailing Address - Fax:
Practice Address - Street 1:7432 E BATES DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-6013
Practice Address - Country:US
Practice Address - Phone:480-229-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty