Provider Demographics
NPI:1497965040
Name:BRIDGMAN PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:BRIDGMAN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DYANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRESLER
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:269-465-4000
Mailing Address - Street 1:7889 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106
Mailing Address - Country:US
Mailing Address - Phone:269-465-4000
Mailing Address - Fax:269-465-4001
Practice Address - Street 1:7889 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106
Practice Address - Country:US
Practice Address - Phone:269-465-4000
Practice Address - Fax:269-465-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTIN