Healthcare Provider Details

I. General information

NPI: 1184033268
Provider Name (Legal Business Name): BRIGHT FUTURES AEI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 PARKWAY DR
SANTA FE NM
87507-7262
US

IV. Provider business mailing address

PO BOX 8741
SANTA FE NM
87504-8741
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-4505
  • Fax: 505-471-4505
Mailing address:
  • Phone: 505-471-4505
  • Fax: 505-471-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06152
License Number StateNM

VIII. Authorized Official

Name: ZOE MIGEL
Title or Position: EXECUTIVE DIRECTOR
Credential: LISW
Phone: 505-471-4505