| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KILLIAN DRAKE BRIDGES | 1922563956 | 2024-01-06 |
Killian Drake Bridges is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1922563956. Registration indicates Killian Drake Bridges is a provider of access to mental health/behavioral health providers services with a specialization in Behavioral Health & Social Service Providers, Counselor (Behavioral Health & Social Service Providers, Counselor) (Counselor: Mental Health, ) (Behavioral Health/Substance Abuse/Psychiatry, ) (Counselor Mental Health, Behavioral Health & Social Service Providers) (Counselor, ) (Other Service Providers, Community Health Worker) (Community Health Worker, ) (Community Health Worker, Other Service Providers)
| Entity Type | Individual |
| Provider Name | Killian Drake Bridges |
| Practice Office Address | 1212 N CALIFORNIA ST STOCKTON, CA US |
| Practice Office Telephone | 2094680102 |
| Practice Office Fax | 2094682380 |
| Mailing Address | 1212 N CALIFORNIA ST STOCKTON, CA 952021552 US |
| Business Telephone | 2094680102 |
| Business Fax | 2094682380 |
| Code | Practice | License No State |
|---|---|---|
| 101YM0800X | Access to Mental Health/Behavioral Health Providers Behavioral Health & Social Service Providers Counselor Behavioral Health & Social Service Providers Counselor Counselor: Mental Health Behavioral Health/Substance Abuse/Psychiatry Counselor Mental Health Behavioral Health & Social Service Providers Counselor | |
| 172V00000X PRIMARY | Other Service Providers Community Health Worker Community Health Worker Community Health Worker Other Service Providers |