Healthcare Provider Details

I. General information

NPI: 1679127187
Provider Name (Legal Business Name): BRIDGES OF THE MIND PSYCHOLOGICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HARBOR BLVD STE 206
WEST SACRAMENTO CA
95691-3828
US

IV. Provider business mailing address

2101 STONE BLVD STE 175
WEST SACRAMENTO CA
95691-4055
US

V. Phone/Fax

Practice location:
  • Phone: 530-302-5791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIKA FRIEZE
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PSY.D.
Phone: 530-302-5791