Organization
BRIDGEWATER COUNSELING
Active
Organization
BRIDGEWATER COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN MARIE MOORE LCSW (THERAPIST)
(573) 673-0517
Entity
Organization
Contact information
Practice address
1949 JACKSON ST, COLUMBIA, MO 65202-3134
(573) 567-0188
Mailing address
1949 JACKSON ST, COLUMBIA, MO 65202-3134
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2017035746
MO
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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