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General NPI Number Information
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NPI Number | 1114536661
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Entity Type | Organization
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Legal Business Name | BRIGHT YOUNG MINDS LLC
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 2614 NW 97TH AVE
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City | DORAL
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State | FL
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Zip | 33172-1413
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Country | US
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Telephone | 786-587-3038
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Fax |
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Provider Business Mailing Address
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Address Line | 2614 NW 97TH AVE
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City | DORAL
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State | FL
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Zip | 33172-1413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LISSY SANCHEZ
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Credential |
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Telephone | 786-587-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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