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General NPI Number Information
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NPI Number | 1811188360
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Entity Type | Organization
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Legal Business Name | BRIDGES EDUCATIONAL SERVICES FOR CHILDREN WITH AUTISM, INC.
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 6501 CYPRESS POINT WAY NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-6411
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Country | US
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Telephone | 505-379-1550
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Fax | 800-714-4705
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Provider Business Mailing Address
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Address Line | 6501 CYPRESS POINT WAY NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-6411
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Country | US
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Telephone | 505-379-1550
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Fax | 800-714-4705
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Authorized Official
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Title or Position | OWNER
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Name | STACY ERTLE
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Credential | MS, LPCC
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Telephone | 505-379-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0084951
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License Number State | NM
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