Provider Demographics
NPI:1447598404
Name:DEBOER, BRIDGETTE (MA)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:DEBOER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 SALLY LN
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-8240
Mailing Address - Country:US
Mailing Address - Phone:775-450-6632
Mailing Address - Fax:
Practice Address - Street 1:1422 MISSION ST
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5239
Practice Address - Country:US
Practice Address - Phone:775-782-4202
Practice Address - Fax:775-782-5055
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00854101YA0400X
NVMI0334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health