Provider Demographics
NPI:1790842581
Name:WOOLBAUGH, BRIDGET LEE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:LEE
Last Name:WOOLBAUGH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 EAST MANHATTAN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-0553
Mailing Address - Country:US
Mailing Address - Phone:406-284-3995
Mailing Address - Fax:
Practice Address - Street 1:610 EAST MANHATTAN AVENUE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741-0553
Practice Address - Country:US
Practice Address - Phone:406-284-3995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT667101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional