Provider Demographics
NPI:1336750785
Name:THE BRIDGE: COUNSELING, PSYCHOTHERAPY, AND WELLNESS
Entity type:Organization
Organization Name:THE BRIDGE: COUNSELING, PSYCHOTHERAPY, AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-743-5889
Mailing Address - Street 1:7987 63RD ST S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-6019
Mailing Address - Country:US
Mailing Address - Phone:612-743-5889
Mailing Address - Fax:612-446-5780
Practice Address - Street 1:7987 63RD ST S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-6019
Practice Address - Country:US
Practice Address - Phone:612-743-5889
Practice Address - Fax:612-446-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty