Healthcare Provider Details

I. General information

NPI: 1801790340
Provider Name (Legal Business Name): TIERNY RENEE BRIDGES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W MARKET ST
LEWISBURG PA
17837-1236
US

IV. Provider business mailing address

409 AIKEY HILL RD
LEWISBURG PA
17837-7739
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-9477
  • Fax:
Mailing address:
  • Phone: 570-492-3815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: