Healthcare Provider Details

I. General information

NPI: 1891453486
Provider Name (Legal Business Name): BRIDGES BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 1/2 SOUTH PENNSYLVANIA AVENUE
WELLSTON OH
45692
US

IV. Provider business mailing address

1024 1/2 SOUTH PENNSYLVANIA AVENUE
WELLSTON OH
45692
US

V. Phone/Fax

Practice location:
  • Phone: 740-384-7771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA VARNEY
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 740-384-7771