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General NPI Number Information
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NPI Number | 1942988852
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Entity Type | Organization
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Legal Business Name | 49TH BRIDGE COUNSELING LLC
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 213 N STEPHANIE ST STE G288
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City | HENDERSON
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State | NV
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Zip | 89074-8117
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Country | US
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Telephone | 907-771-0536
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Fax | 888-467-5306
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Provider Business Mailing Address
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Address Line | 213 N STEPHANIE ST STE G288
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City | HENDERSON
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State | NV
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Zip | 89074-8117
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Country | US
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Telephone | 907-771-0536
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Fax | 888-467-5306
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Authorized Official
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Title or Position | MANAGER
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Name | THERESA M RONCO
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Credential |
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Telephone | 907-748-9890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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