| Light Bridge Counseling Group Llc | |
|
3238 Nw 47th Ave Coconut Creek FL 33063-1800 | |
| (954) 205-6773 | |
| Not Available |
| Full Name | Light Bridge Counseling Group Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 3238 Nw 47th Ave, Coconut Creek, Florida |
| Authorized Official Name and Position | Gavin Vanderwal Malcolm (OWNER) |
| Authorized Official Contact | 9542056773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Bridge Counseling Group Llc 3238 Nw 47th Ave Coconut Creek FL 33063-1800 Ph: (954) 205-6773 | Light Bridge Counseling Group Llc 3238 Nw 47th Ave Coconut Creek FL 33063-1800 Ph: (954) 205-6773 |
| NPI Number | 1770446312 |
|---|---|
| Provider Enumeration Date | 12/09/2025 |
| Last Update Date | 12/09/2025 |
| Certification Date | 12/09/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770446312 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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