Provider Demographics
NPI:1386471605
Name:REPAIRING THE BRIDGE
Entity type:Organization
Organization Name:REPAIRING THE BRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:LASAC, TIC
Authorized Official - Phone:520-701-4575
Mailing Address - Street 1:20740 N MADISON DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-8437
Mailing Address - Country:US
Mailing Address - Phone:520-701-4575
Mailing Address - Fax:
Practice Address - Street 1:20740 N MADISON DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-8437
Practice Address - Country:US
Practice Address - Phone:520-701-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency