Healthcare Provider Details

I. General information

NPI: 1467923797
Provider Name (Legal Business Name): THE LEARNING BRIDGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S GREEN VALLEY PKWY
HENDERSON NV
89012-2301
US

IV. Provider business mailing address

1800 N GREEN VALLEY PKWY APT 611
HENDERSON NV
89074-5819
US

V. Phone/Fax

Practice location:
  • Phone: 702-267-5800
  • Fax:
Mailing address:
  • Phone: 702-810-3874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE L GAMBLE JR.
Title or Position: OWNER
Credential: RBT, B.S.
Phone: 702-810-3874