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BRIDGES EMOTIONAL WELLNESS CLINIC INC NPI 1437375888


NPI Information

NPI: 1437375888
Provider Name: BRIDGES EMOTIONAL WELLNESS CLINIC, INC
Classification: Social Worker - 1041C0700X
Entity Type: Organization

Specialization: Clinical

Address:
4235 FLAGSTAFF COVE
FORT WAYNE, IN
ZIP 46815
Phone: (260) 969-6600
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BRIDGES EMOTIONAL WELLNESS CLINIC, INC is a clinical social worker in Fort Wayne, IN. The provider is a social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. BRIDGES EMOTIONAL WELLNESS CLINIC, INC NPI is 1437375888. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4235 FLAGSTAFF COVE
FORT WAYNE, IN
ZIP 46815-418
Phone: (260) 969-6600
Fax: (260) 969-6601

The provider's authorized official is Agnes Cecilia Osterholt-polston .
The authorized official title is President and has the following contact phone number (260) 969-6600.

The enumeration date for this NPI number is 4/17/2007 and was last updated on 7/1/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1106H00000XMarriage & Family TherapistNo
2101YM0800XCounselorMental HealthNo
31041C0700XSocial WorkerClinicalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1216230MEDICARE PININDIANA
2200373680MEDICAIDINDIANA
3216260MEDICARE ID-TYPE UNSPECIFIEDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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