# LIFE BRIDGES, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700928876
- **Authorized official:** MRS. DIANA JACKSON (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (423) 472-5268

## Contact information

- **Practice address:** 764 OLD CHATTANOOGA PK., CLEVELAND, TN 37311
- **Practice address phone:** (423) 472-5268
- **Practice address fax:** (423) 479-1492
- **Mailing address:** PO BOX 29, CLEVELAND, TN 37364-0029
- **Mailing address phone:** (423) 472-5268
- **Mailing address fax:** (423) 479-1492

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | LPC0000000617 | TN | — |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | — |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | — |
| 2084N0400X | Neurology Physician | 20193 | TN | — |
| 225X00000X | Occupational Therapist | OT2755 | TN | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |
| 363A00000X | Physician Assistant | 1509 | TN | — |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 06/04/2025