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General NPI Number Information
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NPI Number | 1750396636
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY COUNSELING CENTER, LC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1630 23RD AVE SUITE 301B
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City | LEWISTON
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State | ID
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Zip | 83501-6350
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Country | US
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Telephone | 208-746-6776
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Fax | 208-746-1938
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Provider Business Mailing Address
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Address Line | 317 15TH AVE
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City | LEWISTON
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State | ID
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Zip | 83501-2757
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Country | US
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Telephone | 208-746-6776
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Fax | 208-746-1938
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Authorized Official
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Title or Position | OWNER
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Name | FRANK E SHULL
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Credential | M.ED.
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Telephone | 208-746-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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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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