Healthcare Provider Details

I. General information

NPI: 1649856089
Provider Name (Legal Business Name): BRIGHT MENTAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 SW 288TH ST STE 407
HOMESTEAD FL
33033-1243
US

IV. Provider business mailing address

15600 SW 288TH ST STE 407
HOMESTEAD FL
33033-1243
US

V. Phone/Fax

Practice location:
  • Phone: 786-674-2256
  • Fax:
Mailing address:
  • Phone: 786-674-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KLEMNYS ROMERO
Title or Position: VICE-PRESIDENT
Credential:
Phone: 305-928-0333