MEDICARE: BEHAVIORAL BRIDGES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1043031545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL BRIDGES LLC

Provider Business Mailing Address
First Line	:	7010 FAIRMILE RUN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-4927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8410 IBM DR APT 529
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4580
Country	:	US
Telephone Number	:	605-323-5787
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	I'EISHA TURNER
Credential	:
Telephone Number	:	605-323-5787

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/22/2025

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