Provider Demographics
NPI:1508168337
Name:BRIDGING HOPE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:BRIDGING HOPE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WALDOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:763-291-5505
Mailing Address - Street 1:21000 ROGERS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4652
Mailing Address - Country:US
Mailing Address - Phone:763-291-5505
Mailing Address - Fax:763-657-0819
Practice Address - Street 1:311 BRIGHTON AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2312
Practice Address - Country:US
Practice Address - Phone:763-291-5505
Practice Address - Fax:763-657-0819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1894261Q00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health