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General NPI Number Information
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NPI Number | 1154947489
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Entity Type | Organization
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Legal Business Name | BUILDING BRIDGES BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 411 DULLES DR APT 2213
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City | LAFAYETTE
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State | LA
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Zip | 70506-3079
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Country | US
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Telephone | 985-387-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 411 DULLES DR APT 2213
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City | LAFAYETTE
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State | LA
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Zip | 70506-3079
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | AMELIA GEORGE
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Credential | LPC, NCC
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Telephone | 985-228-4449
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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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