=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881562783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTERMIND PSYCHIATRIC AND WELLNESS SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2025
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11118 SUPERIOR LNDG
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20720-3491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-479-5931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11118 SUPERIOR LNDG
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20720-3491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-479-5931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DELLY BRIGHT MUKETE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-479-5931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------