Provider Demographics
NPI:1477040905
Name:BRIDGMAN, KYLE DAVID (LMFT)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:DAVID
Last Name:BRIDGMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 N ACADEMY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2733
Mailing Address - Country:US
Mailing Address - Phone:719-246-5693
Mailing Address - Fax:
Practice Address - Street 1:1785 N ACADEMY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2733
Practice Address - Country:US
Practice Address - Phone:719-246-5693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000183743Medicaid