Healthcare Provider Details

I. General information

NPI: 1629405337
Provider Name (Legal Business Name): BRIDGE CONSULTING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 W PALM LN STE 240
PHOENIX AZ
85037-4448
US

IV. Provider business mailing address

9520 W PALM LN STE 240
PHOENIX AZ
85037-4448
US

V. Phone/Fax

Practice location:
  • Phone: 623-289-1654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11290
License Number StateAZ

VIII. Authorized Official

Name: LATONYA WHITAKER
Title or Position: DIRECTOR
Credential:
Phone: 623-289-1654