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General NPI Number Information
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NPI Number | 1922718196
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Entity Type | Organization
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Legal Business Name | BRIGHTSIDE WELLNESS LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 7100 W GRANDVIEW RD #1126
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City | PEORIA
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State | AZ
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Zip | 85382-4911
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Country | US
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Telephone | 602-708-9253
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Fax |
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Provider Business Mailing Address
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Address Line | 7100 W GRANDVIEW RD APT 1126
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City | PEORIA
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State | AZ
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Zip | 85382-4911
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Country | US
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Telephone | 602-708-9253
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CINDY JEPTOO BETT
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Credential | NP
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Telephone | 602-708-9253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #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 |
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Taxonomy #3
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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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 | 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 #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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