Provider Demographics
NPI:1871802363
Name:BRIDGES OF WEST MICHIGAN PLLC
Entity type:Organization
Organization Name:BRIDGES OF WEST MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:231-468-2550
Mailing Address - Street 1:2721 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8748
Mailing Address - Country:US
Mailing Address - Phone:231-468-2550
Mailing Address - Fax:
Practice Address - Street 1:2721 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8748
Practice Address - Country:US
Practice Address - Phone:231-468-2550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002628101YP2500X
MI6401004741101YP2500X
MI6301009040103TC0700X
MI68010600671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty