Organization
BRIDGE TO HOPE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY MOUSTOUKKIS LCSW (LICENSED THERAPIST)
(309) 455-5703
Entity
Organization
Contact information
Practice address
1012 EKSTAM DR STE 3, BLOOMINGTON, IL 61704-6383
(309) 455-5703
Mailing address
1012 EKSTAM DR STE 3, BLOOMINGTON, IL 61704-6383
(309) 455-5703
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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