Provider Demographics
NPI:1992093330
Name:JEFFRIES, BRIDGET M
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-6312
Mailing Address - Country:US
Mailing Address - Phone:702-493-0220
Mailing Address - Fax:
Practice Address - Street 1:5465 REFLEX DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89156-4606
Practice Address - Country:US
Practice Address - Phone:702-979-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health