MEDICARE: REGINA BRIDGES LCPC

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	180010942	IL

General Provider Information

NPI Number	:	1457774671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA BRIDGES LCPC

Provider Business Mailing Address
First Line	:	5016 N UNIVERSITY ST STE 105
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-4763
Country	:	US
Telephone Number	:	309-727-8797
Fax Number	:

Provider Business Practice Location Address
First Line	:	5016 N UNIVERSITY ST STE 105
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61614-4763
Country	:	US
Telephone Number	:	309-727-8797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	02/14/2026

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