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General NPI Number Information
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NPI Number | 1386811776
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Entity Type | Organization
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Legal Business Name | BRIDGMAN PSYCHOLOGICAL SERVICES, P.C.
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 22792 CENTRE DR STE 290
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City | LAKE FOREST
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State | CA
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Zip | 92630-6304
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Country | US
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Telephone | 949-707-6633
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Fax | 949-770-5433
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Provider Business Mailing Address
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Address Line | 22792 CENTRE DR STE 290
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City | LAKE FOREST
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State | CA
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Zip | 92630-6304
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Country | US
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Telephone | 949-707-6633
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Fax | 949-770-5433
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAIRD BRIDGMAN
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Credential | PSY.D.
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Telephone | 949-707-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC28928
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY14510
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License Number State | CA
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