Healthcare Provider Details

I. General information

NPI: 1265337315
Provider Name (Legal Business Name): MINDBRIDGE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MARKET WAY # 18344
MOUNT POCONO PA
18344-1039
US

IV. Provider business mailing address

126 MARKET WAY # 18344
MOUNT POCONO PA
18344-1039
US

V. Phone/Fax

Practice location:
  • Phone: 570-807-6226
  • Fax:
Mailing address:
  • Phone: 570-807-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LOUISE EVANGELINE KNIGHT-LONG
Title or Position: SOLE PROPRIETOR
Credential:
Phone: 570-807-6226