=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407067788
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN E. BRIDGES SR. M.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 03/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 H ST STE 8
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94509-1279
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-997-2464
-----------------------------------------------------
Fax | 925-756-6097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2922
-----------------------------------------------------
City | ANTIOCH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94531-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-997-2464
-----------------------------------------------------
Fax | 925-757-6459
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 50811
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------