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General NPI Number Information
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NPI Number | 1578248118
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Entity Type | Organization
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Legal Business Name | HIDDEN BRIDGES, LLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 1949 SUGARLAND DR STE 122
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City | SHERIDAN
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State | WY
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Zip | 82801-5763
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Country | US
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Telephone | 307-429-0644
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Fax | 307-675-4920
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Provider Business Mailing Address
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Address Line | 1454 N HEIGHTS LN
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City | SHERIDAN
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State | WY
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Zip | 82801-2123
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Country | US
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Telephone | 307-751-0032
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Fax | 307-675-4920
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | JULIE NICKS-IRVINE
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Credential | LPC, NCC
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Telephone | 307-429-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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