MEDICARE: BRIDGE COUNSELING & CONSULTATION SERVICES 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1720792948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE COUNSELING & CONSULTATION SERVICES PLLC

Provider Business Mailing Address
First Line	:	14337 24TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-3403
Country	:	US
Telephone Number	:	206-745-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	3876 BRIDGE WAY N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-7951
Country	:	US
Telephone Number	:	206-745-5234
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. YOKO SHIBATA
Credential	:	PH.D.
Telephone Number	:	206-745-2344

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/11/2023

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