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General NPI Number Information
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NPI Number | 1790594000
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Entity Type | Organization
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Legal Business Name | BRIGHTSTAR CHILDREN'S THERAPY, LLP
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Dates
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Enumeration Date | 01/01/2025
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 10540 EXCELSIOR BLVD
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City | HOPKINS
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State | MN
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Zip | 55343-3428
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Country | US
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Telephone | 952-228-5906
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Fax | 218-416-9417
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Provider Business Mailing Address
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Address Line | 10540 EXCELSIOR BLVD
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City | HOPKINS
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State | MN
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Zip | 55343-3428
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Country | US
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Telephone | 952-228-5906
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Fax | 218-416-9417
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Authorized Official
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Title or Position | CEO
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Name | HASHIM AIDEED
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Credential |
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Telephone | 952-228-5906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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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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