Provider Demographics
NPI:1588032312
Name:SHOCKEY, BRIDGETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:SHOCKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:
Other - Last Name:FOGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 GALLERY CIR 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3341
Mailing Address - Country:US
Mailing Address - Phone:210-787-1227
Mailing Address - Fax:210-579-1516
Practice Address - Street 1:116 GALLERY CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3340
Practice Address - Country:US
Practice Address - Phone:210-787-1227
Practice Address - Fax:210-579-1516
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56572101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health