Healthcare Provider Details

I. General information

NPI: 1205749413
Provider Name (Legal Business Name): BRIGHT PATH BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 N 19TH AVE STE 203
PHOENIX AZ
85021-7980
US

IV. Provider business mailing address

7550 N 19TH AVE STE 203
PHOENIX AZ
85021-7980
US

V. Phone/Fax

Practice location:
  • Phone: 602-736-9481
  • Fax:
Mailing address:
  • Phone: 602-736-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: FATU TAWOLEY
Title or Position: OWNER
Credential:
Phone: 214-432-6794