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General NPI Number Information
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NPI Number | 1174128128
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Entity Type | Organization
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Legal Business Name | BRIDGES BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 932 W STATE HIGHWAY 152
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City | MUSTANG
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State | OK
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Zip | 73064-2301
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Country | US
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Telephone | 405-577-5477
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Fax | 405-577-5488
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Provider Business Mailing Address
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Address Line | PO BOX 1280
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City | BETHANY
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State | OK
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Zip | 73008-1280
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Country | US
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Telephone | 405-613-4354
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CYNTHIA KEISER
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Credential |
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Telephone | 405-593-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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