Provider Demographics
NPI:1982901724
Name:SANDSTONE BRIDGE CENTER, LLC
Entity Type:Organization
Organization Name:SANDSTONE BRIDGE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCAC, LCMFT
Authorized Official - Phone:785-823-7400
Mailing Address - Street 1:134 S SANTA FE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-2877
Mailing Address - Country:US
Mailing Address - Phone:785-823-7400
Mailing Address - Fax:785-823-7400
Practice Address - Street 1:134 S SANTA FE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-2877
Practice Address - Country:US
Practice Address - Phone:785-823-7400
Practice Address - Fax:785-823-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS403101YA0400X
KS854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200630800AMedicaid