Healthcare Provider Details

I. General information

NPI: 1982182317
Provider Name (Legal Business Name): BRIGHT FUTURES BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N MAIN ST
BEAVER DAM KY
42320
US

IV. Provider business mailing address

1625 N MAIN ST
BEAVER DAM KY
42320-8963
US

V. Phone/Fax

Practice location:
  • Phone: 270-775-5758
  • Fax: 270-274-0696
Mailing address:
  • Phone: 270-775-5758
  • Fax: 270-274-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3002835
License Number StateKY

VIII. Authorized Official

Name: SUSAN MATTHEWS
Title or Position: OWNER
Credential: APRN
Phone: 270-775-8000