MEDICARE: BRIGHT MORNING STAR MINISTRIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1174035455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT MORNING STAR MINISTRIES

Provider Business Mailing Address
First Line	:	2650 S FORUM DR APT 19102
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-7051
Country	:	US
Telephone Number	:	972-854-6186
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 NORTH FWY STE 111
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76102-1702
Country	:	US
Telephone Number	:	682-978-6752
Fax Number	:	214-810-8824

Authorized Official
Title or Position	:	PROGRAM MGR/COUNSELOR
Name	:	MRS. ANITA JEANETTE GLASTER
Credential	:	LMSW
Telephone Number	:	692-978-6752

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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Directions to “BRIGHT MORNING STAR MINISTRIES ” Practice Location

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