Healthcare Provider Details

I. General information

NPI: 1811765266
Provider Name (Legal Business Name): BRIGHT CHANGE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 INDUSTRIAL PARK RD STE 20
OREM UT
84057-2803
US

IV. Provider business mailing address

931 INDUSTRIAL PARK RD STE 20
OREM UT
84057-2803
US

V. Phone/Fax

Practice location:
  • Phone: 385-269-0727
  • Fax:
Mailing address:
  • Phone: 385-269-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JULIE CHACON
Title or Position: OWNDER
Credential: LCSW
Phone: 385-269-0727