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1396279824 NPI number — THE BRIDGES WELLNESS GROUP, LLC.

NPI Number: 1396279824
Health Care Provider/Practitioner: THE BRIDGES WELLNESS GROUP, LLC.

Information about “1396279824” NPI (THE BRIDGES WELLNESS GROUP, LLC.) exists in 1396279824 in HTML format HTML  |  1396279824 in plain Text format TXT  |  1396279824 in PDF (Portable Document Format) PDF  |  1396279824 in an XML format XML  formats.

NPI Number : 1396279824 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396279824",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE BRIDGES WELLNESS GROUP, LLC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7050 CHESAPEAKE RD STE 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HYATTSVILLE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "20784-2345",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "240-770-7204",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7050 CHESAPEAKE RD STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HYATTSVILLE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "20784",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "407-707-2042",
    "PracticeLocationAddressFaxNumber": "866-473-0669",
    "EnumerationDate": "04/11/2017",
    "LastUpdateDate": "05/01/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BATTLE",
    "AuthorizedOfficialFirstName": "MARVIN",
    "AuthorizedOfficialMiddleName": "NICKLESON",
    "AuthorizedOfficialTitle": "CHIEF OPERATING OFFICER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": "JR.",
    "AuthorizedOfficialCredential": "LCPC, LPC",
    "AuthorizedOfficialTelephoneNumber": "703-225-9118",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QM0801X",
          "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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