Healthcare Provider Details

I. General information

NPI: 1174433049
Provider Name (Legal Business Name): BRIDGE-IT MIND BODY PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10203 NE 29TH PL
BELLEVUE WA
98004-1935
US

IV. Provider business mailing address

10203 NE 29TH PL
BELLEVUE WA
98004-1935
US

V. Phone/Fax

Practice location:
  • Phone: 425-214-2217
  • Fax:
Mailing address:
  • Phone: 425-214-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRIDGITTE C MATHIASEN
Title or Position: OWNER
Credential:
Phone: 425-214-2217