MEDICARE: BRIDGES BEHAVIORAL HEALTH LLC

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

General Provider Information

NPI Number	:	1790269272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	PO BOX 494101
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34749-4101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 E SILVER SPRINGS BLVD STE 137
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34470-6830
Country	:	US
Telephone Number	:	352-437-6633
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROGRAM DIRECTOR
Name	:	MRS. LATESHA L LANIER-BROWN
Credential	:	M.S.
Telephone Number	:	352-682-9160

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	09/20/2018

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