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General NPI Number Information
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NPI Number | 1083122428
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Entity Type | Organization
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Legal Business Name | THE BRIDGE YOUTH & FAMILY COUNSELING SERVICES, INC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 5384 SAVANNAH PKWY
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City | SOUTHAVEN
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State | MS
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Zip | 38672-7515
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Country | US
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Telephone | 870-270-8796
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2182
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City | SOUTHAVEN
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State | MS
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Zip | 38671-2201
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Country | US
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Telephone | 713-582-2836
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CALVIN COSEN
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Credential |
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Telephone | 870-270-8796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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