Provider Demographics
NPI:1134972276
Name:STEVENS, BRIDGET KELLY (MED, LPCC, NCC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:KELLY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MED, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1903
Mailing Address - Country:US
Mailing Address - Phone:612-978-7726
Mailing Address - Fax:612-752-8301
Practice Address - Street 1:1900 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1903
Practice Address - Country:US
Practice Address - Phone:612-978-7726
Practice Address - Fax:612-752-8301
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health