Provider Demographics
NPI:1154177152
Name:BRIDGES, MARY HALEY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HALEY
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:712 PACIFIC ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2428
Mailing Address - Country:US
Mailing Address - Phone:719-510-3166
Mailing Address - Fax:
Practice Address - Street 1:1500 ROSECRANS AVE STE 500
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3771
Practice Address - Country:US
Practice Address - Phone:866-474-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist