Healthcare Provider Details
I. General information
NPI: 1538679238
Provider Name (Legal Business Name): BRIGHTER HORIZONS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/07/2017
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
912 W PINE ST
HATTIESBURG MS
39401-4262
US
IV. Provider business mailing address
77 SAINT ANNES DR
HATTIESBURG MS
39401-8252
US
V. Phone/Fax
- Phone: 601-447-4658
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MELANIE
DALE
Title or Position: OWNER
Credential: BCBA
Phone: 601-447-4658