Healthcare Provider Details

I. General information

NPI: 1396592663
Provider Name (Legal Business Name): BRIGHT PATH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SE COURT AVE STE 202
PENDLETON OR
97801-2228
US

IV. Provider business mailing address

PO BOX 1867
PENDLETON OR
97801-0930
US

V. Phone/Fax

Practice location:
  • Phone: 541-862-4357
  • Fax:
Mailing address:
  • Phone: 541-862-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL M EMMONS
Title or Position: ADMINISTRATOR
Credential: CRM, CADC-R
Phone: 541-246-5902