Provider Demographics
NPI:1457767980
Name:FAMILY BRIDGES COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY BRIDGES COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROSHTO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:337-274-8017
Mailing Address - Street 1:4131 CANAL ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-3362
Mailing Address - Country:US
Mailing Address - Phone:337-274-8017
Mailing Address - Fax:833-713-2641
Practice Address - Street 1:4131 CANAL ST STE B
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-3362
Practice Address - Country:US
Practice Address - Phone:337-274-8017
Practice Address - Fax:833-713-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-04
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty