Healthcare Provider Details

I. General information

NPI: 1851931695
Provider Name (Legal Business Name): BRIDGING THE GAP TREATMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SW 4TH ST
REDMOND OR
97756-1838
US

IV. Provider business mailing address

150 SW 4TH ST
REDMOND OR
97756-1838
US

V. Phone/Fax

Practice location:
  • Phone: 541-699-6998
  • Fax: 541-527-4458
Mailing address:
  • Phone: 541-699-6998
  • Fax: 541-527-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHEL LEAH CARTRETTE-MOORE
Title or Position: EXECUTIVE DIRECTOR
Credential: CADC
Phone: 541-408-8023