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General NPI Number Information
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NPI Number | 1922518547
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Entity Type | Organization
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Legal Business Name | BRIGHTER PATH COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 7828 HAVEN AVE STE 102
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3049
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Country | US
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Telephone | 909-782-8382
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Fax | 909-365-3576
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Provider Business Mailing Address
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Address Line | PO BOX 1176
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City | FONTANA
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State | CA
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Zip | 92334-1176
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Country | US
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Telephone | 909-782-8382
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Fax | 909-365-3576
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JAVIER MARTIN PANAMENO CAMPOS
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Credential | LCSW
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Telephone | 909-782-8382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 26127
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License Number State | CA
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Taxonomy #2
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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 | CA
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