Provider Demographics
NPI:1821516329
Name:MAYER, BRIDGET MANLEY (LMFT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MANLEY
Last Name:MAYER
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 1:333 GALAHAD RD N
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1021
Mailing Address - Country:US
Mailing Address - Phone:612-250-1268
Mailing Address - Fax:
Practice Address - Street 1:366 SELBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2886
Practice Address - Country:US
Practice Address - Phone:651-829-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist