Organization
THE BRIDGE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON KERRICK LCSW (OWNER)
(208) 410-4866
Entity
Organization
Contact information
Practice address
493 EASTLAND DR, TWIN FALLS, ID 83301-7441
(208) 410-4866
Mailing address
2818 SUNRAY LOOP, TWIN FALLS, ID 83301-6700
(208) 720-2969
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811349129
NPI
ID
Enumeration date
06/17/2019
Last updated
08/19/2019
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