MEDICARE: BRIDGES MENTAL HEALTH SERVICES

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1669119871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES MENTAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	9701 BROOKPARK RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44129-6824
Country	:	US
Telephone Number	:	216-630-7586
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 BROOKPARK RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44129-6824
Country	:	US
Telephone Number	:	216-630-7586
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YVETTE GIVAND
Credential	:	LCSW
Telephone Number	:	419-571-6327

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/23/2022

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