MEDICARE: KINDBRIDGE BEHAVIORAL HEALTH, INC

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	:	1952916124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDBRIDGE BEHAVIORAL HEALTH, INC

Provider Business Mailing Address
First Line	:	200 W MARTIN LUTHER KING BLVD STE 1029B
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-2560
Country	:	US
Telephone Number	:	404-414-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W MARTIN LUTHER KING BLVD STE 1029B
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37402-2560
Country	:	US
Telephone Number	:	404-414-3700
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	ROBERT C JORDSHAUGEN
Credential	:
Telephone Number	:	404-414-3700

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	04/24/2025

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