Provider Demographics
NPI:1316198674
Name:GILBERT BRIDWELL, DARCY (MA)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:GILBERT BRIDWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:390 SW COLUMBIA ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3227
Mailing Address - Country:US
Mailing Address - Phone:541-382-2333
Mailing Address - Fax:541-388-0479
Practice Address - Street 1:390 SW COLUMBIA ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3227
Practice Address - Country:US
Practice Address - Phone:541-382-2333
Practice Address - Fax:541-388-0479
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC2389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health