Provider Demographics
NPI:1659821478
Name:ST JOHN, BRIDGET (LMFT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 S MERIDIAN
Mailing Address - Street 2:STE C #176
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0366
Mailing Address - Country:US
Mailing Address - Phone:206-372-7081
Mailing Address - Fax:
Practice Address - Street 1:105B W MAIN STE 115
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5329
Practice Address - Country:US
Practice Address - Phone:206-372-7081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60906723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist