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General NPI Number Information
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NPI Number | 1467106294
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Entity Type | Organization
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Legal Business Name | BRIGHTLIGHT OASIS PSYCHIATRY AND COUNSELING PLLC
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 04/28/2023
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Provider Practice Location Address
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Address Line | 2000 E LAMAR BLVD STE 600
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City | ARLINGTON
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State | TX
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Zip | 76006-7361
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Country | US
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Telephone | 503-662-9385
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Fax | 316-661-1877
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Provider Business Mailing Address
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Address Line | 547 BRETON DR
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City | GRAND PRAIRIE
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State | TX
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Zip | 75052-2525
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Country | US
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Telephone | 503-662-9385
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Fax | 316-661-1877
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Authorized Official
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Title or Position | PROVIDER
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Name | AYISHA SANDA
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Credential | PMHNP
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Telephone | 503-662-9385
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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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