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General NPI Number Information
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NPI Number | 1649192907
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY PSYCHOLOGICAL AND COUNSELING SERVICES PLLC
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 1777 E CLARK ST STE 210
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City | POCATELLO
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State | ID
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Zip | 83201-3357
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Country | US
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Telephone | 208-203-2088
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Fax |
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Provider Business Mailing Address
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Address Line | 1777 E CLARK ST STE 210
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City | POCATELLO
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State | ID
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Zip | 83201-3357
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Country | US
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Telephone | 208-203-2088
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW B OLSEN
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Credential | LCSW
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Telephone | 208-203-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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