| Koni B. Bridges, Lcsw Llc | |
|
1918 Maplewood Dr Sulphur LA 70663-6006 | |
| (337) 625-5664 | |
| (337) 625-5660 |
| Full Name | Koni B. Bridges, Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1918 Maplewood Dr, Sulphur, Louisiana |
| Authorized Official Name and Position | Koni B. Bridges (OWNER) |
| Authorized Official Contact | 3376255664 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Koni B. Bridges, Lcsw Llc 1918 Maplewood Dr Sulphur LA 70663-6006 Ph: (337) 625-5664 | Koni B. Bridges, Lcsw Llc 1918 Maplewood Dr Sulphur LA 70663-6006 Ph: (337) 625-5664 |
| NPI Number | 1770882847 |
|---|---|
| Provider Enumeration Date | 03/15/2011 |
| Last Update Date | 03/15/2011 |
| Medicare PECOS PAC ID | 2062695448 |
|---|---|
| Medicare Enrollment ID | O20110322000842 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770882847 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 2739 (Louisiana) | Primary |
| Provider Name | Koni B Bridges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295915387 PECOS PAC ID: 4385783422 Enrollment ID: I20091202000284 |
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