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General NPI Number Information
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NPI Number | 1710867510
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Entity Type | Organization
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Legal Business Name | BRIGHTPATH MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 1350 84TH LN N
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City | BROOKLYN PARK
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State | MN
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Zip | 55444-1443
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Country | US
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Telephone | 651-246-4705
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Fax | 612-315-4916
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Provider Business Mailing Address
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Address Line | 1350 84TH LN N
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City | BROOKLYN PARK
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State | MN
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Zip | 55444-1443
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Country | US
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Telephone | 651-246-4705
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Fax | 612-315-4916
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Authorized Official
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Title or Position | PMHNP
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Name | SHAKLEEN SHAKUR
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Credential | APRN
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Telephone | 651-246-4705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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