Healthcare Provider Details

I. General information

NPI: 1588200091
Provider Name (Legal Business Name): BRIGHT MIND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SW SHEVLIN HIXON DR
BEND OR
97702-3209
US

IV. Provider business mailing address

121 NW BOND ST
BEND OR
97703-3207
US

V. Phone/Fax

Practice location:
  • Phone: 541-717-3033
  • Fax:
Mailing address:
  • Phone: 206-225-8780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY KREUTZER ERBER
Title or Position: NURSE PRACTITIONER OWNER, PRESIDENT
Credential: NP
Phone: 541-717-3033