Healthcare Provider Details

I. General information

NPI: 1215316807
Provider Name (Legal Business Name): BRIGHT START EARLY INTERVENTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 1/2 NORTH MAIN STREET
HENDERSON KY
42419-0066
US

IV. Provider business mailing address

PO BOX 66
HENDERSON KY
42419-0066
US

V. Phone/Fax

Practice location:
  • Phone: 270-860-9594
  • Fax: 270-458-0022
Mailing address:
  • Phone: 270-860-9594
  • Fax: 270-458-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1004
License Number StateKY

VIII. Authorized Official

Name: ERICA CAITLIN CONLEY
Title or Position: LISCENSED BEHAVIOR ANALYSIS IN KY
Credential: BCABA, MED
Phone: 270-860-9594