Healthcare Provider Details

I. General information

NPI: 1003454364
Provider Name (Legal Business Name): BRIDGES COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E BELTLINE CT NE
GRAND RAPIDS MI
49525-9494
US

IV. Provider business mailing address

3280 E BELTLINE CT NE
GRAND RAPIDS MI
49525-9494
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-3404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: GAYLE M WITHAM
Title or Position: LMSW
Credential:
Phone: 616-477-3404