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General NPI Number Information
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NPI Number | 1508237702
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Entity Type | Organization
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Legal Business Name | BEHAVIOR BRIDGES
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 17404 MERIDIAN E SUITE F125
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City | PUYALLUP
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State | WA
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Zip | 98375-6234
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Country | US
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Telephone | 253-262-3409
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Fax |
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Provider Business Mailing Address
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Address Line | 17404 MERIDIAN E SUITE F125
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City | PUYALLUP
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State | WA
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Zip | 98375-6234
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Country | US
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Telephone | 253-262-3409
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LAURA B. O'ROURKE
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Credential | M.S., BCBA
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Telephone | 253-262-3409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60579014
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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