Bridging the Gap Wellness and Behavioral Group

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

65704412 Issued in IL

Legal business name

BRIDGING THE GAP WELLNESS AND BEHAVIORAL GROUP

Practice address

17953 Edwards Ave
Country Club Hills, IL 60478-5184

Phone

(773) 818-1854

NPI assigned

Jan 19, 2008

Organization subpart

No

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

Authorized official

Name

Ms. Alice J Gibson, LCPC

Title

Vice President

Phone

(773) 818-1854

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1200700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200700800000",
    "number": "1841476983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17953 EDWARDS AVE",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604785184",
            "telephone_number": "773-818-1854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17953 EDWARDS AVE",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604785184",
            "telephone_number": "773-818-1854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGING THE GAP WELLNESS AND BEHAVIORAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-19",
        "last_updated": "2008-01-19",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "773-818-1854",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "65704412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Country Club Hills, IL
• Providers in Country Club Hills, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2008; 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.