Provider Demographics
NPI:1720804305
Name:BRIDGING MENTAL HEALTH
Entity type:Organization
Organization Name:BRIDGING MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSEBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-910-0607
Mailing Address - Street 1:7801 E BUSH LAKE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3152
Mailing Address - Country:US
Mailing Address - Phone:612-599-8366
Mailing Address - Fax:
Practice Address - Street 1:7801 E BUSH LAKE RD STE 130
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3152
Practice Address - Country:US
Practice Address - Phone:612-599-8366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health