Provider Demographics
NPI:1891264164
Name:BRIDGES, MAEGAN
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 N BENTON ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-2501
Mailing Address - Country:US
Mailing Address - Phone:573-433-2833
Mailing Address - Fax:573-525-7072
Practice Address - Street 1:119 N BENTON ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2501
Practice Address - Country:US
Practice Address - Phone:573-433-2833
Practice Address - Fax:573-525-7072
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor