Provider Demographics
NPI:1326410986
Name:BRIDGES TO CHANGE
Entity Type:Organization
Organization Name:BRIDGES TO CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TREATMENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CADCII
Authorized Official - Phone:503-858-7073
Mailing Address - Street 1:PO BOX 16576
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7916 SE FOSTER RD STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-4289
Practice Address - Country:US
Practice Address - Phone:503-465-2749
Practice Address - Fax:503-208-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500703921Medicaid