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General NPI Number Information
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NPI Number | 1982901724
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Entity Type | Organization
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Legal Business Name | SANDSTONE BRIDGE CENTER, LLC
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 134 S SANTA FE AVE SUITE 130
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City | SALINA
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State | KS
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Zip | 67401-2877
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Country | US
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Telephone | 785-823-7400
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Fax | 785-823-7400
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Provider Business Mailing Address
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Address Line | 134 S SANTA FE AVE SUITE 130
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City | SALINA
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State | KS
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Zip | 67401-2877
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Country | US
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Telephone | 785-823-7400
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Fax | 785-823-7400
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MINDY J NICHOLSON
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Credential | LCAC, LCMFT
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Telephone | 785-823-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 403
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 854
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License Number State | KS
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