MEDICARE: BRIDGEWELL COGNITIVE HEALTH

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1053270504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEWELL COGNITIVE HEALTH

Provider Business Mailing Address
First Line	:	988 BLUE JAY WAY
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-8307
Country	:	US
Telephone Number	:	469-382-4264
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 N CENTRAL EXPY STE 670
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-3158
Country	:	US
Telephone Number	:	469-382-4264
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & CLINICAL DIRECTOR
Name	:	NYLA HARRIS
Credential	:	PSYD
Telephone Number	:	469-382-4264

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	05/12/2026

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Directions to “BRIDGEWELL COGNITIVE HEALTH ” Practice Location

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