Provider Demographics
NPI:1982210621
Name:BRIDGE BUILDERS COUNSELING, L.L.C.
Entity Type:Organization
Organization Name:BRIDGE BUILDERS COUNSELING, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LADC
Authorized Official - Phone:402-741-2876
Mailing Address - Street 1:712 W KOENIG ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6556
Mailing Address - Country:US
Mailing Address - Phone:402-741-9444
Mailing Address - Fax:
Practice Address - Street 1:712 W KOENIG ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6556
Practice Address - Country:US
Practice Address - Phone:402-741-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026844900Medicaid