MEDICARE: BRIGHTER LIFE PSYCHIATRIC SERVICES

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1114771383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER LIFE PSYCHIATRIC SERVICES

Provider Business Mailing Address
First Line	:	9436 W LAKE MEAD BLVD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-8340
Country	:	US
Telephone Number	:	951-642-8201
Fax Number	:

Provider Business Practice Location Address
First Line	:	9436 W LAKE MEAD BLVD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-8340
Country	:	US
Telephone Number	:	951-642-8201
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRINESHA GARLAND
Credential	:
Telephone Number	:	951-642-8201

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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