Healthcare Provider Details

I. General information

NPI: 1285064386
Provider Name (Legal Business Name): BRIGHTER HORIZONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RICHARDS AVE
GILLETTE WY
82716-3632
US

IV. Provider business mailing address

301 RICHARDS AVE
GILLETTE WY
82716-3632
US

V. Phone/Fax

Practice location:
  • Phone: 307-685-6982
  • Fax:
Mailing address:
  • Phone: 307-685-6982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number101YP2500X
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number101YP2500X
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number101YP2500X
License Number StateWY

VIII. Authorized Official

Name: MRS. CARRIE STRAWN
Title or Position: OWNER
Credential: MA, LPC, NCC
Phone: 307-685-6982