Bridges Emotional Wellness Clinic, Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BRIDGES EMOTIONAL WELLNESS CLINIC, INC

Practice address

4235 Flagstaff Cove
Fort Wayne, IN 46815-4418

Phone

(260) 969-6600

Fax

(260) 969-6601

NPI assigned

Apr 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Agnes Cecilia Osterholt-PolstonNPI 1255346011

Title

President

Phone

(260) 969-6600

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Agnes Cecilia Osterholt-Polston, MSW,LCSWS

  • Clinical Social Worker
  • Fort Wayne, IN
  • NPI 1255346011
  Medicare reassignment NPD Authorized official
• Belinda Mae Justus, ACSW, LCSW

  • Clinical Social Worker
  • Fort Wayne, IN
  • NPI 1457505232
  NPD (past)
• Randall J. Rider, MS, LSW, LMFT

  • Marriage & Family Therapist
  • Fort Wayne, IN
  • NPI 1982737722
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1437375888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4235 FLAGSTAFF COVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154418",
            "telephone_number": "260-969-6600",
            "fax_number": "260-969-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 FLAGSTAFF COVE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468154418",
            "telephone_number": "260-969-6600",
            "fax_number": "260-969-6601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGES EMOTIONAL WELLNESS CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "OSTERHOLT-POLSTON",
        "authorized_official_first_name": "AGNES",
        "authorized_official_middle_name": "CECILIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-969-6600"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200373680",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea Bridge
• Bridges Dialysis LLC (Fort Wayne South Dialysis)
• Bridges Dialysis LLC (Appleseed Dialysis)
• Bridges Dialysis LLC (Fort Wayne West Dialysis)
• Bridges Dialysis LLC (Summit City Dialysis)
• Christian H Bridgwater, DO
• Kristine Briggs-Connelly, MSPT
• William F. Brigham, OD
• Bright Beginnings1
• Bright Life ABA

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.