Provider Demographics
NPI:1275246688
Name:BRIDGE COUNSELING
Entity Type:Organization
Organization Name:BRIDGE COUNSELING
Other - Org Name:THE BRIDGE COUNSELING, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-799-1691
Mailing Address - Street 1:255 MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:NM
Mailing Address - Zip Code:88431-9001
Mailing Address - Country:US
Mailing Address - Phone:575-799-1691
Mailing Address - Fax:
Practice Address - Street 1:214 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2223
Practice Address - Country:US
Practice Address - Phone:575-799-1691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty