MEDICARE: BRIDGING THE GAP COUNSELING SERVICES PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053171512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING THE GAP COUNSELING SERVICES PLLC

Provider Business Mailing Address
First Line	:	21203 FOXWOOD ROCK TRL
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-1995
Country	:	US
Telephone Number	:	832-217-8445
Fax Number	:

Provider Business Practice Location Address
First Line	:	21203 FOXWOOD ROCK TRL
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-1995
Country	:	US
Telephone Number	:	832-217-8445
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA ROCHELLE GOODSON
Credential	:	LPC
Telephone Number	:	832-217-8445

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/21/2024

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