Healthcare Provider Details

I. General information

NPI: 1568038222
Provider Name (Legal Business Name): BRIDGEWAY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SHELL AVE SE
FORT WALTON BEACH FL
32548-5808
US

IV. Provider business mailing address

137 HOSPITAL DR NE
FORT WALTON BEACH FL
32548-5015
US

V. Phone/Fax

Practice location:
  • Phone: 850-833-7500
  • Fax: 850-833-7528
Mailing address:
  • Phone: 850-833-3975
  • Fax: 850-883-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BONNIE R BARLOW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 850-833-3975