Provider Demographics
NPI:1285311720
Name:BRIDGE LIFE COUNSELING, PLLC
Entity type:Organization
Organization Name:BRIDGE LIFE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TEISHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOPPE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:779-537-8544
Mailing Address - Street 1:1120 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-5315
Mailing Address - Country:US
Mailing Address - Phone:779-537-8544
Mailing Address - Fax:
Practice Address - Street 1:1120 FREMONT ST
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-5315
Practice Address - Country:US
Practice Address - Phone:779-537-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty