Individual provider Active NPI

Kyle David Bridgman, LMFT

  • Marriage & Family Therapist
  • Colorado Springs, CO
National Provider Identifier
1477040905
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT.0001770 Issued in CO
Practice address
1785 N Academy Blvd Ste 100
Colorado Springs, CO 80909-2733
Phone
(719) 246-5693
NPI assigned
Apr 19, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X MFT.0001770 CO Primary

Addresses

Primary practice location

1785 N Academy Blvd Ste 100
Colorado Springs, CO 80909-2733

Mailing address

1785 N Academy Blvd Ste 100
Colorado Springs, CO 80909-2733
Phone (719) 246-5693

Other identifiers 1

IdentifierTypeStateIssuer
9000183743MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MFT.0001770COMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Project Ember Counseling Marriage & Family Therapist Current Accepting new patients
Project Ember Counseling Marriage & Family Therapist Current Accepting new patients
Project Ember Initiative Marriage & Family Therapist CurrentSince Jul 7, 2024 Accepting new patients

Locations

5540 N Academy Blvd
Ste 210
Colorado Springs, CO 80918
Phone (719) 330-3366

4360 Montebello Dr
Ste 400
Colorado Springs, CO 80918
Phone (719) 593-9228

1785 N Academy Blvd
Ste 100
Colorado Springs, CO 80909
Phone (719) 246-5693

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1477040905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1785 N ACADEMY BLVD STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809092733",
            "telephone_number": "719-246-5693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1785 N ACADEMY BLVD STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809092733",
            "telephone_number": "719-246-5693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGMAN",
        "first_name": "KYLE",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-19",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CO",
            "license": "MFT.0001770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000183743",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.