Provider Demographics
NPI:1811188360
Name:BRIDGES EDUCATIONAL SERVICES FOR CHILDREN WITH AUTISM, INC.
Entity Type:Organization
Organization Name:BRIDGES EDUCATIONAL SERVICES FOR CHILDREN WITH AUTISM, INC.
Other - Org Name:BRIDGES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC
Authorized Official - Phone:505-379-1550
Mailing Address - Street 1:6501 CYPRESS POINT WAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6411
Mailing Address - Country:US
Mailing Address - Phone:505-379-1550
Mailing Address - Fax:800-714-4705
Practice Address - Street 1:6501 CYPRESS POINT WAY NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-6411
Practice Address - Country:US
Practice Address - Phone:505-379-1550
Practice Address - Fax:800-714-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0084951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22306854Medicaid
NMVNM01024OtherVALUE OPTIONS OF NM