Provider Demographics
NPI:1386147189
Name:BRIDGETT MARIE LITTEL, LLC
Entity type:Organization
Organization Name:BRIDGETT MARIE LITTEL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:651-272-7462
Mailing Address - Street 1:4304 TRENTON TRL
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1958
Mailing Address - Country:US
Mailing Address - Phone:651-272-7462
Mailing Address - Fax:
Practice Address - Street 1:801 DODD RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5725
Practice Address - Country:US
Practice Address - Phone:651-272-7462
Practice Address - Fax:855-401-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty