Organization
BRIDGING THE GAP WELLNESS AND BEHAVIORAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALICE J GIBSON LCPC (VICE PRESIDENT)
(773) 818-1854
Entity
Organization
Contact information
Practice address
17953 EDWARDS AVE, COUNTRY CLUB HILLS, IL 60478-5184
(773) 818-1854
Mailing address
17953 EDWARDS AVE, COUNTRY CLUB HILLS, IL 60478-5184
(773) 818-1854
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
65704412
IL
Other
Enumeration date
01/19/2008
Last updated
01/19/2008
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