Organization
BRIDGE STREET COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES DESHAZER LMFT, LAC (OWNER)
(720) 263-2256
Entity
Organization
Contact information
Practice address
203 TELLURIDE ST UNIT 600, BRIGHTON, CO 80601-4366
(720) 263-2256
(303) 659-8803
Mailing address
203 TELLURIDE ST UNIT 600, BRIGHTON, CO 80601-4366
(720) 263-2256
(303) 659-8803
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACD234
LICENSED ADDICTION COUNSELOR
CO
01
—
MFT1617
LICENSED MARRIAGE AND FAMILY THERAPIST
CO
Enumeration date
09/24/2019
Last updated
09/24/2019
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