Healthcare Provider Details

I. General information

NPI: 1235823709
Provider Name (Legal Business Name): BRIDGEWAY BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 MCLEOD RD NE STE P
ALBUQUERQUE NM
87109-2468
US

IV. Provider business mailing address

PO BOX 45681
RIO RANCHO NM
87174-5681
US

V. Phone/Fax

Practice location:
  • Phone: 505-549-2385
  • Fax:
Mailing address:
  • Phone: 505-226-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEANNA SMITH
Title or Position: OWNER
Credential: LMFT
Phone: 505-549-2385