Provider Demographics
NPI:1568651503
Name:BRIDGEWAYS COUNSELING & CONSULTATION,INC.
Entity Type:Organization
Organization Name:BRIDGEWAYS COUNSELING & CONSULTATION,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:KLIBER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW,MSW,ACSW
Authorized Official - Phone:507-285-1776
Mailing Address - Street 1:2746 SUPERIOR DR NW
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8343
Mailing Address - Country:US
Mailing Address - Phone:507-285-1776
Mailing Address - Fax:507-285-1773
Practice Address - Street 1:2746 SUPERIOR DR NW
Practice Address - Street 2:SUITE 270
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8343
Practice Address - Country:US
Practice Address - Phone:507-285-1776
Practice Address - Fax:507-285-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN218M2BROtherBCBS MN
MN218M2BROtherBCBS MN