Provider Demographics
NPI:1720792948
Name:BRIDGE COUNSELING & CONSULTATION SERVICES PLLC
Entity Type:Organization
Organization Name:BRIDGE COUNSELING & CONSULTATION SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOKO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIBATA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-745-2344
Mailing Address - Street 1:14337 24TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-3403
Mailing Address - Country:US
Mailing Address - Phone:206-745-2344
Mailing Address - Fax:
Practice Address - Street 1:3876 BRIDGE WAY N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7951
Practice Address - Country:US
Practice Address - Phone:206-745-5234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty