| Healing Bridge Llc | |
|
1358 E Kingsley St Ste E Springfield MO 65804-7245 | |
| (417) 414-0333 | |
| Not Available |
| Full Name | Healing Bridge Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1358 E Kingsley St Ste E, Springfield, Missouri |
| Authorized Official Name and Position | Stephanie M Wacaser (LLC OWNER/PROVDER) |
| Authorized Official Contact | 4172971952 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Bridge Llc 717 E Placer Mill Rd Nixa MO 65714-7100 Ph: () - | Healing Bridge Llc 1358 E Kingsley St Ste E Springfield MO 65804-7245 Ph: (417) 414-0333 |
| NPI Number | 1891266375 |
|---|---|
| Provider Enumeration Date | 12/10/2018 |
| Last Update Date | 12/10/2018 |
| Medicare PECOS PAC ID | 3173860384 |
|---|---|
| Medicare Enrollment ID | O20190125002426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891266375 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Stephanie M Wacaser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619200490 PECOS PAC ID: 5092840322 Enrollment ID: I20160125001732 |
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