Provider Demographics
NPI:1356926604
Name:BRIDGEWAY ABA THERAPY, LLC
Entity type:Organization
Organization Name:BRIDGEWAY ABA THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:334-363-3359
Mailing Address - Street 1:2751 LEGENDS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-7754
Mailing Address - Country:US
Mailing Address - Phone:334-363-3359
Mailing Address - Fax:334-625-1853
Practice Address - Street 1:215 DEER RUN DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3835
Practice Address - Country:US
Practice Address - Phone:334-363-3359
Practice Address - Fax:334-625-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty