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General NPI Number Information
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NPI Number | 1609141860
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Entity Type | Organization
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Legal Business Name | THE BRIDGE YOUTH AND FAMILY COUNSELING
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 14002 GARDEN BROOK CT
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City | ROSHARON
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State | TX
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Zip | 77583-2066
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Country | US
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Telephone | 281-536-5475
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Fax | 281-972-9328
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Provider Business Mailing Address
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Address Line | PO BOX 1494
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City | FRESNO
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State | TX
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Zip | 77545-1494
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Country | US
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Telephone | 281-536-5475
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Fax | 281-972-9328
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SHERRIE COOK YOUNG
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Credential | BS
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Telephone | 281-536-5475
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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 | 61830
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 00112953
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License Number State | TX
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