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Organization
FAMILY BRIDGES
Active
Organization
FAMILY BRIDGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRI ORTLIEB LPC (CO-CHAIRMAN OF THE BOARD)
(417) 496-6444
Entity
Organization
Contact information
Practice address
718 S MAIN ST, WILLARD, MO 65781-9797
(417) 742-1000
(417) 742-1001
Mailing address
718 S MAIN ST, WILLARD, MO 65781-9797
(417) 742-1000
(417) 742-1001
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
—
NULL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
NULL
385HR2065X
Child Physical Disabilities Respite Care
—
NULL
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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