Provider Demographics
NPI:1801508528
Name:A BRIDGE 2 HEALING THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:A BRIDGE 2 HEALING THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ENCHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-831-3943
Mailing Address - Street 1:12254 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-6529
Mailing Address - Country:US
Mailing Address - Phone:708-831-3943
Mailing Address - Fax:708-794-0521
Practice Address - Street 1:930 175TH ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2039
Practice Address - Country:US
Practice Address - Phone:708-831-3943
Practice Address - Fax:708-794-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty