Organization
BRIDGEWATER COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE M KELLER LCSW (PSYCHOTHERAPIST)
(618) 520-3339
Entity
Organization
Contact information
Practice address
10551 VONDER HAAR LN, BREESE, IL 62230-4316
(618) 520-3339
Mailing address
10551 VONDER HAAR LN, BREESE, IL 62230-4316
(618) 520-3339
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487841714
NPI
—
01
—
149015007
PROFESSIONAL LICENSE
IL
01
—
2012036897
PROFESSIONAL CLINICAL SOCIAL WORK LICENSE
MO
Enumeration date
06/29/2020
Last updated
07/09/2026
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up