MEDICARE: TRIBAL BRIGHT RESOURCE CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1053183046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIBAL BRIGHT RESOURCE CENTER LLC

Provider Business Mailing Address
First Line	:	7776 S POINTE PKWY W STE 260
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5407
Country	:	US
Telephone Number	:	702-715-6718
Fax Number	:	602-431-3181

Provider Business Practice Location Address
First Line	:	7776 S POINTE PKWY W STE 260
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-5407
Country	:	US
Telephone Number	:	702-715-6718
Fax Number	:	602-431-3181

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	SHERITA WALKER
Credential	:
Telephone Number	:	702-715-6178

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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