MEDICARE: BRIDGES COMMUNITY SUPPORT SERVICES

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427226612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES COMMUNITY SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	3155 SUTTON BLVD STE 201
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-3917
Country	:	US
Telephone Number	:	314-781-7900
Fax Number	:	314-781-7914

Provider Business Practice Location Address
First Line	:	3155 SUTTON BLVD STE 201
Second Line	:
City	:	MAPLEWOOD
State	:	MO
Zip	:	63143-3917
Country	:	US
Telephone Number	:	314-781-7900
Fax Number	:	314-781-7914

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BARRY J LARSON
Credential	:
Telephone Number	:	314-781-7900

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	09/28/2022

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