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General NPI Number Information
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NPI Number | 1285437244
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Entity Type | Organization
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Legal Business Name | BRIGHT PATH PSYCHIATRY PLLC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 752 OFFICERS ROW
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City | VANCOUVER
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State | WA
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Zip | 98661-3845
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Country | US
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Telephone | 360-996-1071
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Fax |
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Provider Business Mailing Address
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Address Line | 2807 N PIONEER CANYON DR
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City | RIDGEFIELD
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State | WA
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Zip | 98642-7524
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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 | OWNER
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Name | SOPHIA RAEVOURI
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Credential |
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Telephone | 360-996-1071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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