Healthcare Provider Details

I. General information

NPI: 1801473673
Provider Name (Legal Business Name): BRIDGES PSYCHOTHERAPY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 HAWKS REST DR
MAPLETON UT
84664-5006
US

IV. Provider business mailing address

1034 HAWKS REST DR
MAPLETON UT
84664-5006
US

V. Phone/Fax

Practice location:
  • Phone: 888-330-6277
  • Fax:
Mailing address:
  • Phone: 888-330-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PHILIP SCOTT RICHARDS
Title or Position: PRESIDENT
Credential: PH.D. LICENSED PSYCH
Phone: 888-330-6277