Provider Demographics
NPI:1902493851
Name:BRIDGEWAY COUNSELING LLC
Entity Type:Organization
Organization Name:BRIDGEWAY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIFATAH
Authorized Official - Middle Name:ISSE
Authorized Official - Last Name:NUUH
Authorized Official - Suffix:
Authorized Official - Credentials:MAHHSA/ALD
Authorized Official - Phone:612-242-0673
Mailing Address - Street 1:4204 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3312
Mailing Address - Country:US
Mailing Address - Phone:612-242-0673
Mailing Address - Fax:
Practice Address - Street 1:4204 16TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3312
Practice Address - Country:US
Practice Address - Phone:612-242-0673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-27
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty