Healthcare Provider Details

I. General information

NPI: 1649148289
Provider Name (Legal Business Name): JOHN GREGORY BRIDGES-MUSIC LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 HINCKLEY RD
CANAAN ME
04924-3321
US

IV. Provider business mailing address

656 HINCKLEY RD
CANAAN ME
04924-3321
US

V. Phone/Fax

Practice location:
  • Phone: 207-299-5031
  • Fax:
Mailing address:
  • Phone: 207-299-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC5707
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: