Provider Demographics
NPI:1427226612
Name:BRIDGES COMMUNITY SUPPORT SERVICES
Entity type:Organization
Organization Name:BRIDGES COMMUNITY SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-781-7900
Mailing Address - Street 1:3155 SUTTON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3917
Mailing Address - Country:US
Mailing Address - Phone:314-781-7900
Mailing Address - Fax:314-781-7914
Practice Address - Street 1:3155 SUTTON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3917
Practice Address - Country:US
Practice Address - Phone:314-781-7900
Practice Address - Fax:314-781-7914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503292203Medicaid
MO000013875Medicare PIN