Organization
BRIDGE TO ADULTHOOD, LLC
Active
Parent organization
2025
Organization subpart
Yes
Provider details
NPI number
Legal business name
2025
Authorized official
BRIAN COMLEY BA (PROGRAM DIRECTOR)
(270) 987-4456
Entity
Organization
Contact information
Practice address
5345 RUSSELLVILLE RD, ALLENSVILLE, KY 42204-9024
(270) 987-4456
(888) 270-7319
Mailing address
5345 RUSSELLVILLE RD, ALLENSVILLE, KY 42204-9024
(270) 987-4456
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
253242
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100496400
—
KY
Enumeration date
04/26/2018
Last updated
04/23/2020
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