Healthcare Provider Details

I. General information

NPI: 1083932263
Provider Name (Legal Business Name): THE BRIDGE HEALTH CLINICS & RESEARCH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W WALNUT ST SUITE 33-R
MILWAUKEE WI
53212-3863
US

IV. Provider business mailing address

2200 N MAYFAIR RD SUITE 200
WAUWATOSA WI
53226-2252
US

V. Phone/Fax

Practice location:
  • Phone: 414-831-4500
  • Fax: 414-255-3451
Mailing address:
  • Phone: 414-258-9511
  • Fax: 414-607-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TODD C. CAMPBELL
Title or Position: PRESIDENT / CEO
Credential: PHD
Phone: 414-831-4500