Provider Demographics
NPI:1528161411
Name:BRIDGES, DARYL A (LCPC)
Entity type:Individual
Prefix:MS
First Name:DARYL
Middle Name:A
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 W.HAYS
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5028
Mailing Address - Country:US
Mailing Address - Phone:208-345-2207
Mailing Address - Fax:208-336-7125
Practice Address - Street 1:1408 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5028
Practice Address - Country:US
Practice Address - Phone:208-345-2207
Practice Address - Fax:208-336-7125
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-74101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health