Healthcare Provider Details

I. General information

NPI: 1285563668
Provider Name (Legal Business Name): BRIDGE PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10069 N 65TH ST
LONGMONT CO
80503-9077
US

IV. Provider business mailing address

607 LINCOLN ST
LONGMONT CO
80501-4430
US

V. Phone/Fax

Practice location:
  • Phone: 303-253-2187
  • Fax:
Mailing address:
  • Phone: 303-253-2187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SORIN THOMAS
Title or Position: OWNER
Credential: LPC
Phone: 303-253-2187