Provider Demographics
NPI:1326277625
Name:BRIDGEWAY COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:BRIDGEWAY COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BURI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:605-886-5262
Mailing Address - Street 1:600 4TH ST NE STE 203
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1898
Mailing Address - Country:US
Mailing Address - Phone:605-886-5262
Mailing Address - Fax:605-886-5228
Practice Address - Street 1:600 4TH ST NE STE 203
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1898
Practice Address - Country:US
Practice Address - Phone:605-886-5262
Practice Address - Fax:605-886-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 103T00000X, 103TC1900X, 103TF0000X, 103TH0004X, 104100000X, 1041C0700X, 103TE1100X, 103TF0000X, 103TH0004X, 104100000X, 1041C0700X, 103T00000X
SD375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1003928Medicaid
SD6551302Medicaid