Healthcare Provider Details

I. General information

NPI: 1750396636
Provider Name (Legal Business Name): BRIDGEWAY COUNSELING CENTER, LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 23RD AVE SUITE 301B
LEWISTON ID
83501-6350
US

IV. Provider business mailing address

317 15TH AVE
LEWISTON ID
83501-2757
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-6776
  • Fax: 208-746-1938
Mailing address:
  • Phone: 208-746-6776
  • Fax: 208-746-1938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FRANK E SHULL
Title or Position: OWNER
Credential: M.ED.
Phone: 208-746-6776