# BRIDGE TO ADULTHOOD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** 2025
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356839187
- **Legal business name:** 2025
- **Authorized official:** BRIAN COMLEY BA (PROGRAM DIRECTOR)
- **Authorized official phone:** (270) 987-4456

## Contact information

- **Practice address:** 5345 RUSSELLVILLE RD, ALLENSVILLE, KY 42204-9024
- **Practice address phone:** (270) 987-4456
- **Practice address fax:** (888) 270-7319
- **Mailing address:** 5345 RUSSELLVILLE RD, ALLENSVILLE, KY 42204-9024
- **Mailing address phone:** (270) 987-4456

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |
| 1041C0700X | Clinical Social Worker | 253242 | KY | — |

## Other

- **Enumeration date:** 04/26/2018
- **Last updated:** 04/23/2020