Healthcare Provider Details

I. General information

NPI: 1063053882
Provider Name (Legal Business Name): BRIGHTER LIFE OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 W CHARLESTON BLVD STE 190
LAS VEGAS NV
89102-1978
US

IV. Provider business mailing address

325 N GIBSON RD APT 1421
HENDERSON NV
89014-6748
US

V. Phone/Fax

Practice location:
  • Phone: 702-849-9185
  • Fax:
Mailing address:
  • Phone: 702-849-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SEAN CHRISTOPHER SIMMONS
Title or Position: MANAGING MEMBER
Credential:
Phone: 702-849-9185