Provider Demographics
NPI:1790269272
Name:BRIDGES BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:BRIDGES BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATESHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANIER-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:352-682-9160
Mailing Address - Street 1:PO BOX 494101
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-4101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 E SILVER SPRINGS BLVD STE 137
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6830
Practice Address - Country:US
Practice Address - Phone:352-437-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty