Healthcare Provider Details

I. General information

NPI: 1306718226
Provider Name (Legal Business Name): YOUR BRIDGE OF HOPE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W SAINT PAUL AVE UNIT 197
MILWAUKEE WI
53201-2211
US

IV. Provider business mailing address

345 W SAINT PAUL AVE UNIT 197
MILWAUKEE WI
53201-2211
US

V. Phone/Fax

Practice location:
  • Phone: 414-368-0256
  • Fax: 414-413-4542
Mailing address:
  • Phone: 414-368-0256
  • Fax: 414-413-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TAM'MEKA M BERRY
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: PHD
Phone: 414-368-0256