Healthcare Provider Details

I. General information

NPI: 1689867467
Provider Name (Legal Business Name): BRIDGES FOR L.I.F.E. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 BELLVUE AVENUE
MEMPHIS TN
38104-0334
US

IV. Provider business mailing address

PO BOX 334
MEMPHIS TN
38101-0334
US

V. Phone/Fax

Practice location:
  • Phone: 901-517-3406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET L TATE
Title or Position: EXCUTIVE MANAGER/OWNER
Credential:
Phone: 901-517-3406