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General NPI Number Information
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NPI Number | 1417355736
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Entity Type | Individual
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Provider Name | LYNN BRIDGERS
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Gender | Female
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 12/18/2014
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Provider Practice Location Address
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Address Line | 4300 SILVER AVE SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2748
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Country | US
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Telephone | 505-255-1804
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Fax | 505-265-4446
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Provider Business Mailing Address
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Address Line | 7705 SPRING AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7331
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Country | US
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Telephone | 505-268-0318
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Fax | 505-265-4446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0169561
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0169561
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License Number State | NM
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