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Individual

BRIDGET TEAL DERKASH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC, LAC

Contact information

Practice address
PO BOX 1115, BASALT, CO 81621-1115
(970) 924-0703
Mailing address
PO BOX 1115, BASALT, CO 81621-1115
(970) 924-0703

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0001797
CO
101YP2500X
Professional Counselor
Primary
LPC.0014689
CO

Other

Enumeration date
04/09/2025
Last updated
04/09/2025
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