Provider Demographics
NPI:1144577503
Name:HEADY, BRIDGET LISA (LMHC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:LISA
Last Name:HEADY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 S CONGRESS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7670
Mailing Address - Country:US
Mailing Address - Phone:561-653-6292
Mailing Address - Fax:
Practice Address - Street 1:7570 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-6060
Practice Address - Country:US
Practice Address - Phone:844-463-3968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 8633101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health