Healthcare Provider Details

I. General information

NPI: 1982366761
Provider Name (Legal Business Name): BRIGHTER DAYS WELLNESS & BEHAVIOR ANALYSIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2021
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 W MAIN ST
ANTLERS OK
74523-2059
US

IV. Provider business mailing address

432057 STATE HIGHWAY 3
FORT TOWSON OK
74735-7506
US

V. Phone/Fax

Practice location:
  • Phone: 580-209-6111
  • Fax: 580-209-6179
Mailing address:
  • Phone: 580-372-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GEORGE ALLEN PATE JR.
Title or Position: PRESIDENT
Credential: BCBA
Phone: 580-372-6572