Provider Demographics
NPI:1750396636
Name:BRIDGEWAY COUNSELING CENTER, LC
Entity type:Organization
Organization Name:BRIDGEWAY COUNSELING CENTER, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHULL
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:208-746-6776
Mailing Address - Street 1:317 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2757
Mailing Address - Country:US
Mailing Address - Phone:208-746-6776
Mailing Address - Fax:208-746-1938
Practice Address - Street 1:1630 23RD AVE
Practice Address - Street 2:SUITE 301B
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6350
Practice Address - Country:US
Practice Address - Phone:208-746-6776
Practice Address - Fax:208-746-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty