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General NPI Number Information
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NPI Number | 1508168337
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Entity Type | Organization
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Legal Business Name | BRIDGING HOPE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 311 BRIGHTON AVE S SUITE B
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City | BUFFALO
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State | MN
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Zip | 55313-2312
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Country | US
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Telephone | 763-291-5505
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Fax | 763-657-0819
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Provider Business Mailing Address
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Address Line | 21000 ROGERS DR SUITE 200
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City | ROGERS
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State | MN
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Zip | 55374-4652
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Country | US
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Telephone | 763-291-5505
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Fax | 763-657-0819
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Authorized Official
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Title or Position | LMFT
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Name | HEIDI LYNN WALDOCH
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Credential | MA
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Telephone | 763-291-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 1894
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 1894
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1894
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License Number State | MN
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