Healthcare Provider Details

I. General information

NPI: 1497965040
Provider Name (Legal Business Name): BRIDGMAN PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7889 RED ARROW HWY
BRIDGMAN MI
49106
US

IV. Provider business mailing address

7889 RED ARROW HWY
BRIDGMAN MI
49106
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-4000
  • Fax: 269-465-4001
Mailing address:
  • Phone: 269-465-4000
  • Fax: 269-465-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMI

VIII. Authorized Official

Name: DYANNE C BRESLER
Title or Position: PRESIDENT
Credential: LLP
Phone: 269-465-4000