Provider Demographics
NPI:1689084121
Name:WHITE BRIDLE THERAPY
Entity type:Organization
Organization Name:WHITE BRIDLE THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-740-0900
Mailing Address - Street 1:615 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7218
Mailing Address - Country:US
Mailing Address - Phone:972-740-0990
Mailing Address - Fax:
Practice Address - Street 1:660 KELLER SMITHFIELD RD
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4228
Practice Address - Country:US
Practice Address - Phone:972-940-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097ZNOtherBCBS