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General NPI Number Information
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NPI Number | 1689710311
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Entity Type | Individual
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Provider Name | BEVERLY G. BRIDGE M.S. IN CLINCIAL PSY
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 LAKE BELLEVUE DR SUITE 204
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City | BELLEVUE
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State | WA
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Zip | 98005-2417
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Country | US
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Telephone | 206-441-3556
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Fax | 425-635-0883
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Provider Business Mailing Address
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Address Line | 8400 SE 34TH PLACE
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City | MERCER ISLAND
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State | WA
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Zip | 98040-3026
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Country | US
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Telephone | 206-232-1652
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Fax | 425-635-0883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF00000877
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License Number State | WA
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