Provider Demographics
NPI:1952020570
Name:BRIDGELIGHT COUNSELING
Entity Type:Organization
Organization Name:BRIDGELIGHT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HEAD COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAME
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:262-729-3143
Mailing Address - Street 1:647 W MAIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1993
Mailing Address - Country:US
Mailing Address - Phone:262-729-3143
Mailing Address - Fax:
Practice Address - Street 1:647 W MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1993
Practice Address - Country:US
Practice Address - Phone:262-729-3143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100065492Medicaid