Healthcare Provider Details

I. General information

NPI: 1063340628
Provider Name (Legal Business Name): BRIDGE OVER TROUBLED WATERS COUNSELING, COACHING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 E 100TH ST N APT 20105
OWASSO OK
74055-9336
US

IV. Provider business mailing address

7521 S OLYMPIA AVE # 1060
TULSA OK
74132-1855
US

V. Phone/Fax

Practice location:
  • Phone: 214-924-8766
  • Fax:
Mailing address:
  • Phone: 214-924-8766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRIDGETT JAMISON
Title or Position: OWNER/ THERAPIST
Credential: LCSW
Phone: 214-924-8766