Healthcare Provider Details

I. General information

NPI: 1649674029
Provider Name (Legal Business Name): BRIDGE TO MENTAL HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 CLEMATIS ST SUITE 316
WEST PALM BEACH FL
33401-4608
US

IV. Provider business mailing address

8129 SEDGEWICK CT APT. A
WEST PALM BEACH FL
33406-8472
US

V. Phone/Fax

Practice location:
  • Phone: 561-307-5843
  • Fax: 561-328-3441
Mailing address:
  • Phone: 561-307-5843
  • Fax: 561-328-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH12636
License Number StateFL

VIII. Authorized Official

Name: MS. LINNETTE SANTOS ROBLES
Title or Position: OWNER
Credential: LMHC
Phone: 561-307-5843