Healthcare Provider Details

I. General information

NPI: 1184559312
Provider Name (Legal Business Name): BRIDGE COUNSELING & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 S WATER TOWER PL
MOUNT VERNON IL
62864-6589
US

IV. Provider business mailing address

3600 S WATER TOWER PL
MOUNT VERNON IL
62864-6589
US

V. Phone/Fax

Practice location:
  • Phone: 618-316-3146
  • Fax: 618-244-0535
Mailing address:
  • Phone: 618-316-3146
  • Fax: 618-244-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JAMI HARLAND
Title or Position: OWNER
Credential: LCSW
Phone: 618-316-3146