Healthcare Provider Details

I. General information

NPI: 1184531519
Provider Name (Legal Business Name): BRIGHTPATH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 3RD ST STE 100
ROCHESTER MI
48307-2045
US

IV. Provider business mailing address

2659 PEBBLE BEACH DR
OAKLAND MI
48363-2450
US

V. Phone/Fax

Practice location:
  • Phone: 586-873-3971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: YULIA RAYKINSTEEN
Title or Position: OWNER
Credential:
Phone: 586-873-3971