Provider Demographics
NPI:1538843255
Name:BRIDGES, ANA JULIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:JULIA
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2078 N FREEDOM PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5692
Mailing Address - Country:US
Mailing Address - Phone:479-856-3620
Mailing Address - Fax:
Practice Address - Street 1:480 N CAMPUS WALK
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-4006
Practice Address - Country:US
Practice Address - Phone:479-575-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11-06P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical