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Organization
BRIDGE TO ADULTHOOD, LLC
Active
Organization
BRIDGE TO ADULTHOOD, LLC
Active
Parent organization
2025
Organization subpart
Yes
Provider details
NPI number
Legal business name
2025
Authorized official
BRIAN COMLEY BA (PROGRAM DIRECTOR)
(270) 987-4456
Entity
Organization
Contact information
Practice address
5345 RUSSELLVILLE RD, ALLENSVILLE, KY 42204-9024
(270) 987-4456
(888) 270-7319
Mailing address
5345 RUSSELLVILLE RD, ALLENSVILLE, KY 42204-9024
(270) 987-4456
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
NULL
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
253242
KY
Other
Enumeration date
04/26/2018
Last updated
04/23/2020
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