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General NPI Number Information
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NPI Number | 1386840262
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Entity Type | Organization
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Legal Business Name | THE BRIDGE
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 2925 W T C JESTER BLVD SUITE 5
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City | HOUSTON
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State | TX
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Zip | 77018-7061
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Country | US
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Telephone | 713-697-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 W T C JESTER BLVD SUITE 5
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City | HOUSTON
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State | TX
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Zip | 77018-7061
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Country | US
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Telephone | 713-697-2300
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUNYA R CLAIBORNE
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Credential | OWNER
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Telephone | 713-697-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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