NPIMap

Organization Active NPI

Bridge Builders Counseling and Mentoring Inc

  • Clinical Social Worker
  • Port Huron, MI
National Provider Identifier
1568822971
Registry record updated Feb 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801086434 Issued in MI
Legal business name
BRIDGE BUILDERS COUNSELING AND MENTORING INC
Practice address
1220 6TH St
Port Huron, MI 48060-5349
Phone
(810) 987-8772
Fax
(810) 987-8706
NPI assigned
Feb 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2016

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

Authorized official

Name
Mrs. Ernestine Kimberly Brown, LMSW, CAADC
Title
Clinical Director
Phone
(810) 987-8772

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 6801086434 MI Primary

Addresses

Primary practice location

1220 6TH St
Port Huron, MI 48060-5349

Mailing address

1220 6TH St
Port Huron, MI 48060-5349
Phone (810) 987-8772

Other names 1

  • Bridge Builders Counseling and Mentoring, Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Bridge Builders Counseling and Mentoring Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1220 6th St
Port Huron, MI 48060
Phone (810) 987-8772

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1456444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456444800000",
    "number": "1568822971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 6TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605349",
            "telephone_number": "810-987-8772",
            "fax_number": "810-987-8706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 6TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605349",
            "telephone_number": "810-987-8772",
            "fax_number": "810-987-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGE BUILDERS COUNSELING AND MENTORING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-26",
        "last_updated": "2016-02-26",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "ERNESTINE",
        "authorized_official_middle_name": "KIMBERLY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "810-987-8772",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMSW, CAADC"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801086434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridge Builders Counseling and Mentoring, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; 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.