Bridge Academy Collective

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BRIDGE ACADEMY COLLECTIVE

Doing business as

The Bridge Advocacy and Counseling

Practice address

2904 Brea Blvd
Fullerton, CA 92835-2015

Phone

(951) 805-3467

Fax

(951) 356-7325

NPI assigned

Jan 22, 2024

Last updated

Aug 30, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jacqueline Michele Mack-Harris, LMFT, PSYDNPI 1720560709

Title

Founder/Clinical Director

Phone

(949) 275-2979

Specialties & licenses 2

Addresses

Other names 2

• The Bridge Advocacy and Counseling Doing business as
• The Bridge Academy Collective Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacqueline M Mack-Harris, PSYD, LMFT

  • Marriage & Family Therapist
  • Murrieta, CA
  • NPI 1720560709
  NPD Authorized official

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1790546125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19917 CRESTWOOD DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925300400",
            "telephone_number": "949-275-2979",
            "fax_number": "951-356-7325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 BREA BLVD",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928352015",
            "telephone_number": "951-805-3467",
            "fax_number": "951-356-7325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41197 Golden Gate Cir Ste 207",
            "address_purpose": "LOCATION",
            "city": "Murrieta",
            "state": "CA",
            "postal_code": "925626999",
            "country_code": "US",
            "telephone_number": "951-805-3467",
            "fax_number": "951-356-7325",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "41197 Golden Gate Cir Ste 207",
            "address_purpose": "LOCATION",
            "city": "Murrieta",
            "state": "CA",
            "postal_code": "925626999",
            "country_code": "US",
            "telephone_number": "951-805-3467",
            "fax_number": "951-356-7325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRIDGE ACADEMY COLLECTIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "MACK-HARRIS",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "FOUNDER/CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "949-275-2979",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LMFT, PSYD"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Bridge Advocacy and Counseling",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Bridge Academy Collective",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.