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General NPI Number Information
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NPI Number | 1215316807
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Entity Type | Organization
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Legal Business Name | BRIGHT START EARLY INTERVENTION, LLC
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 121 1/2 NORTH MAIN STREET
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City | HENDERSON
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State | KY
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Zip | 42419-0066
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Country | US
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Telephone | 270-860-9594
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Fax | 270-458-0022
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Provider Business Mailing Address
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Address Line | PO BOX 66
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City | HENDERSON
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State | KY
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Zip | 42419-0066
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Country | US
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Telephone | 270-860-9594
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Fax | 270-458-0022
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Authorized Official
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Title or Position | LISCENSED BEHAVIOR ANALYSIS IN KY
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Name | ERICA CAITLIN CONLEY
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Credential | BCABA, MED
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Telephone | 270-860-9594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1004
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License Number State | KY
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