Provider Demographics
NPI:1689710311
Name:BRIDGE, BEVERLY G (MS IN CLINCIAL PSY)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:G
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:MS IN CLINCIAL PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 SE 34TH PLACE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3026
Mailing Address - Country:US
Mailing Address - Phone:206-232-1652
Mailing Address - Fax:425-635-0883
Practice Address - Street 1:1 LAKE BELLEVUE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2417
Practice Address - Country:US
Practice Address - Phone:206-441-3556
Practice Address - Fax:425-635-0883
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000877106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist