Healthcare Provider Details

I. General information

NPI: 1548084999
Provider Name (Legal Business Name): BRIGHTPATH MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22792 CENTRE DR STE 112
LAKE FOREST CA
92630-6311
US

IV. Provider business mailing address

22792 CENTRE DR STE 112
LAKE FOREST CA
92630-6311
US

V. Phone/Fax

Practice location:
  • Phone: 714-813-6317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEVI SWEET
Title or Position: TECH
Credential:
Phone: 714-813-6317