Provider Demographics
NPI:1427553940
Name:THE BRIDGE COUNSELING, CONSULTING AND MEDIATION LLC
Entity Type:Organization
Organization Name:THE BRIDGE COUNSELING, CONSULTING AND MEDIATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLIRGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:480-203-7165
Mailing Address - Street 1:4625 S. LAKESHORE DR.
Mailing Address - Street 2:302
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-203-7165
Mailing Address - Fax:
Practice Address - Street 1:4625 S. LAKESHORE DR.
Practice Address - Street 2:302
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-203-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty