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General NPI Number Information
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NPI Number | 1194376988
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Entity Type | Organization
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Legal Business Name | BRIDGE STREET COUNSELING
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 203 TELLURIDE ST UNIT 600
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City | BRIGHTON
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State | CO
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Zip | 80601-4366
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Country | US
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Telephone | 720-263-2256
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Fax | 303-659-8803
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Provider Business Mailing Address
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Address Line | 203 TELLURIDE ST UNIT 600
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City | BRIGHTON
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State | CO
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Zip | 80601-4366
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Country | US
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Telephone | 720-263-2256
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Fax | 303-659-8803
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES DESHAZER
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Credential | LMFT, LAC
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Telephone | 720-263-2256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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