Healthcare Provider Details

I. General information

NPI: 1033975685
Provider Name (Legal Business Name): BRIDGE TO WONDERLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 04/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S 39TH ST STE 2E
OMAHA NE
68131-3050
US

IV. Provider business mailing address

200 S 21ST ST STE 400A
LINCOLN NE
68510-1044
US

V. Phone/Fax

Practice location:
  • Phone: 833-384-6916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHELSEA DEL-TORO
Title or Position: OWNER/THERAPIST
Credential: PLMHP, PSS, PHT
Phone: 833-384-6916