Provider Demographics
NPI:1275924276
Name:BRIDGES BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:BRIDGES BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:KINARD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:904-753-0701
Mailing Address - Street 1:1838 PERIMETER PARK RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1975
Mailing Address - Country:US
Mailing Address - Phone:904-753-0701
Mailing Address - Fax:
Practice Address - Street 1:1838 PERIMETER PARK RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1975
Practice Address - Country:US
Practice Address - Phone:904-753-0701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-8789103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty