Provider Demographics
NPI:1659625937
Name:WELLNESS COMPANY VII
Entity Type:Organization
Organization Name:WELLNESS COMPANY VII
Other - Org Name:TRICIA BRIDGEWATER
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRIDGEWATER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-549-0572
Mailing Address - Street 1:1819 W AUSTIN BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-3708
Mailing Address - Country:US
Mailing Address - Phone:417-283-6151
Mailing Address - Fax:417-283-6152
Practice Address - Street 1:1819 W AUSTIN BLVD STE C
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-3708
Practice Address - Country:US
Practice Address - Phone:417-283-6151
Practice Address - Fax:417-283-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999140492103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty