Basic Information
| Provider Information | |||||||||
| NPI: | 1174128128 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRIDGES BEHAVIORAL HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1280 | ||||||||
| Address2: | |||||||||
| City: | BETHANY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730081280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056134354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 932 W STATE HIGHWAY 152 | ||||||||
| Address2: | |||||||||
| City: | MUSTANG | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730642301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055775477 | ||||||||
| FaxNumber: | 4055775488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2020 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | KEISER | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4055931800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.