Healthcare Provider Details

I. General information

NPI: 1659291508
Provider Name (Legal Business Name): BRIDGE BETWEEN COUNSELING & CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 RISCH AVE
SAINT LOUIS MO
63125-1138
US

IV. Provider business mailing address

3717 RISCH AVE
SAINT LOUIS MO
63125-1138
US

V. Phone/Fax

Practice location:
  • Phone: 636-535-3338
  • Fax:
Mailing address:
  • Phone: 636-535-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA NORTHCUTT
Title or Position: OWNER
Credential: LPC
Phone: 636-535-3338