Provider Demographics
NPI:1609466887
Name:SMALL BRIDGES COUNSELING
Entity Type:Organization
Organization Name:SMALL BRIDGES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER 1
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:M
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-375-4439
Mailing Address - Street 1:1562 SAND SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-9060
Mailing Address - Country:US
Mailing Address - Phone:785-375-4439
Mailing Address - Fax:
Practice Address - Street 1:1562 SAND SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-9060
Practice Address - Country:US
Practice Address - Phone:785-375-4439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty