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General NPI Number Information
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NPI Number | 1295408425
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Entity Type | Organization
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Legal Business Name | BRILLIANT FUTURES LLC
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Dates
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Enumeration Date | 07/24/2021
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 126 NELSONS BRIDGE RD
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City | HANOVER
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State | VA
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Zip | 23069-2530
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Country | US
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Telephone | 214-772-4664
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 GREENWAY ST APT A
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City | DENTON
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State | TX
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Zip | 76207-1261
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Country | US
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Telephone | 214-772-4664
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | STACEY REED
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Credential |
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Telephone | 214-772-4664
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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 |
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License Number State |
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