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Organization
MINDBRIDGE GROUP, LLC
Active
Organization
MINDBRIDGE GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE MCEACHIN PHD (EXECUTIVE DIRECTOR)
(917) 576-0305
Entity
Organization
Contact information
Practice address
5520 MUNICIPAL DR BSMT, TOBYHANNA, PA 18466-7714
(917) 576-0305
Mailing address
5130 DERBY RD, TOBYHANNA, PA 18466-8212
(917) 576-0305
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346674975
MICHELLE BACKUS
PA
Enumeration date
01/12/2019
Last updated
01/12/2019
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