MEDICARE: BRIDGET NELSEN GOIN MFT

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	106H00000X	Marriage & Family Therapist	49448	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	49448	OTHER	CA	CA BOARD OF BEHAVIORAL SCIENCES, MFC LICENSE #

General Provider Information

NPI Number	:	1578776134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET NELSEN GOIN MFT

Provider Business Mailing Address
First Line	:	PO BOX 4142
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95063-4142
Country	:	US
Telephone Number	:	831-233-3556
Fax Number	:	831-233-3556

Provider Business Practice Location Address
First Line	:	113 PINE ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95062-3623
Country	:	US
Telephone Number	:	831-233-3556
Fax Number	:	831-233-3556

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	01/10/2024

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