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General NPI Number Information
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NPI Number | 1619177797
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Entity Type | Organization
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Legal Business Name | BRIGHT TOMORROWS, INCORPORATED
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 409 WASHINGTON AVE
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City | POCATELLO
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State | ID
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Zip | 83201-4520
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Country | US
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Telephone | 208-234-2646
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Fax | 208-232-0035
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Provider Business Mailing Address
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Address Line | 409 WASHINGTON AVE
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City | POCATELLO
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State | ID
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Zip | 83201-4520
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Country | US
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Telephone | 208-234-2646
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Fax | 208-232-0035
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CASSIDY MICHELLE ROSKE
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Credential | MCOUN, LPC
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Telephone | 208-234-2646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC 870/LCPC 724
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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