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General NPI Number Information
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NPI Number | 1902493851
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Entity Type | Organization
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Legal Business Name | BRIDGEWAY COUNSELING LLC
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Dates
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Enumeration Date | 12/27/2020
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 4204 16TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3312
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Country | US
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Telephone | 612-242-0673
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Fax |
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Provider Business Mailing Address
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Address Line | 4204 16TH AVE S
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-3312
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Country | US
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Telephone | 612-242-0673
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | ABDIFATAH ISSE NUUH
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Credential | MAHHSA/ALD
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Telephone | 612-242-0673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling 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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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