Organization
BRIDGES EMOTIONAL WELLNESS CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AGNES CECILIA OSTERHOLT-POLSTON (PRESIDENT)
(260) 969-6600
Entity
Organization
Contact information
Practice address
4235 FLAGSTAFF COVE, FORT WAYNE, IN 46815-4418
(260) 969-6600
(260) 969-6601
Mailing address
4235 FLAGSTAFF COVE, FORT WAYNE, IN 46815-4418
(260) 969-6600
(260) 969-6601
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200373680
—
IN
Enumeration date
04/17/2007
Last updated
07/01/2008
Update your record
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