| Bridge To Adulthood, Llc | |
|
5345 Russellville Rd Allensville KY 42204-9024 | |
| (270) 987-4456 | |
| (888) 270-7319 |
| Full Name | Bridge To Adulthood, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 5345 Russellville Rd, Allensville, Kentucky |
| Authorized Official Name and Position | Brian Comley (PROGRAM DIRECTOR) |
| Authorized Official Contact | 2709874456 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge To Adulthood, Llc 5345 Russellville Rd Allensville KY 42204-9024 Ph: (270) 987-4456 | Bridge To Adulthood, Llc 5345 Russellville Rd Allensville KY 42204-9024 Ph: (270) 987-4456 |
| NPI Number | 1356839187 |
|---|---|
| Provider Enumeration Date | 04/26/2018 |
| Last Update Date | 04/23/2020 |
| Certification Date | 04/23/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356839187 | NPI | - | NPPES |
| 7100496400 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | 253242 (Kentucky) | Secondary |