Provider Demographics
NPI:1285428532
Name:DERKASH, BRIDGET TEAL (LPC, LAC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:TEAL
Last Name:DERKASH
Suffix:
Gender:
Credentials:LPC, LAC
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:TEAL
Other - Last Name:JANKOVSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-1115
Mailing Address - Country:US
Mailing Address - Phone:970-924-0703
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1115
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-1115
Practice Address - Country:US
Practice Address - Phone:970-924-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001797101YA0400X
COLPC.0014689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)