Provider Demographics
NPI:1609141860
Name:THE BRIDGE YOUTH AND FAMILY COUNSELING
Entity Type:Organization
Organization Name:THE BRIDGE YOUTH AND FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:281-536-5475
Mailing Address - Street 1:PO BOX 1494
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-1494
Mailing Address - Country:US
Mailing Address - Phone:281-536-5475
Mailing Address - Fax:281-972-9328
Practice Address - Street 1:14002 GARDEN BROOK CT
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2066
Practice Address - Country:US
Practice Address - Phone:281-536-5475
Practice Address - Fax:281-972-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61830101Y00000X
TX00112953101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXMedicaid