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General NPI Number Information
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NPI Number | 1902049315
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Entity Type | Organization
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Legal Business Name | BRIGHTWATER HEALTH DBA HUMAN DEVELOPMENT CENTER
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1500 N 34TH ST
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City | SUPERIOR
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State | WI
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Zip | 54880-4477
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Country | US
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Telephone | 715-392-8216
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Fax | 715-392-6055
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Provider Business Mailing Address
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Address Line | 1401 E 1ST ST
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City | DULUTH
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State | MN
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Zip | 55805-2407
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Country | US
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Telephone | 218-728-4491
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Fax | 218-728-4404
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Authorized Official
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Title or Position | CHIEF EXECUTIVE DIRECTOR
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Name | BENJMAIN HATFIELD
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Credential | MSW, LICSW, LADC
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Telephone | 218-728-4491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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