Provider Demographics
NPI:1124825443
Name:NURTURED BRIDGE THERAPY SERVICES AND CONSULTING, LLC
Entity type:Organization
Organization Name:NURTURED BRIDGE THERAPY SERVICES AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER - CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:SELATY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-914-5988
Mailing Address - Street 1:5901 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:MIDLND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7004
Mailing Address - Country:US
Mailing Address - Phone:586-914-5988
Mailing Address - Fax:
Practice Address - Street 1:5901 WIMBLEDON CT
Practice Address - Street 2:
Practice Address - City:MIDLND
Practice Address - State:MI
Practice Address - Zip Code:48642-7004
Practice Address - Country:US
Practice Address - Phone:586-914-5988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health