MEDICARE: INTERFAITH BRIDGE COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093593378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERFAITH BRIDGE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	7432 E BATES DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-6013
Country	:	US
Telephone Number	:	480-229-7022
Fax Number	:

Provider Business Practice Location Address
First Line	:	7432 E BATES DR
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-6013
Country	:	US
Telephone Number	:	480-229-7022
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LENA HILDER MCCAIN
Credential	:	LPC
Telephone Number	:	480-229-7022

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	01/05/2024

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