| Bridgewater Counseling Services, Llc | |
|
10551 Vonder Haar Ln Breese IL 62230-4316 | |
| (618) 520-3339 | |
| Not Available |
| Full Name | Bridgewater Counseling Services, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 10551 Vonder Haar Ln, Breese, Illinois |
| Authorized Official Name and Position | Renee Marie Keller (PRINCIPAL) |
| Authorized Official Contact | 6185203339 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgewater Counseling Services, Llc 10551 Vonder Haar Ln Breese IL 62230-4316 Ph: (618) 520-3339 | Bridgewater Counseling Services, Llc 10551 Vonder Haar Ln Breese IL 62230-4316 Ph: (618) 520-3339 |
| NPI Number | 1144847880 |
|---|---|
| Provider Enumeration Date | 06/29/2020 |
| Last Update Date | 06/05/2024 |
| Certification Date | 06/05/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144847880 | NPI | - | NPPES |
| 1487841714 | Other | NPI | |
| 2012036897 | Other | MO | PROFESSIONAL CLINICAL SOCIAL WORK LICENSE |
| 149015007 | Other | IL | PROFESSIONAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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