=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457778458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIDGING THE GAP PSYCHCARE. PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2014
-----------------------------------------------------
Last Update Date | 03/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1419 GREENWAY VILLAGE DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-3581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-221-9593
-----------------------------------------------------
Fax | 281-633-9920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1419 GREENWAY VILLAGE DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-3581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-221-9593
-----------------------------------------------------
Fax | 281-633-9920
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST/OWNER
-----------------------------------------------------
Name | ASHLEY E ANGLIN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 281-221-9593
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 68602
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------