Provider Demographics
NPI:1174006084
Name:BRIDGE THERAPEUTIC SERVICES PLLC
Entity Type:Organization
Organization Name:BRIDGE THERAPEUTIC SERVICES PLLC
Other - Org Name:THE BRIDGE THERAPEUTIC SERVICES PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:903-283-8729
Mailing Address - Street 1:3800 PALUXY DR STE 240
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1667
Mailing Address - Country:US
Mailing Address - Phone:903-283-8729
Mailing Address - Fax:888-454-9083
Practice Address - Street 1:3800 PALUXY DR STE 240
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1667
Practice Address - Country:US
Practice Address - Phone:903-283-8729
Practice Address - Fax:888-454-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty