MEDICARE: BRIGHT MINDS THERAPY 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	251E00000X	Home Health Agency	OTA11229	FL

General Provider Information

NPI Number	:	1568862845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT MINDS THERAPY LLC

Provider Business Mailing Address
First Line	:	6275 NW 171ST ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4622
Country	:	US
Telephone Number	:	305-335-6468
Fax Number	:

Provider Business Practice Location Address
First Line	:	6275 NW 171ST ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4622
Country	:	US
Telephone Number	:	305-335-6468
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	STEPHANY HERNANDEZ
Credential	:	COTA/L
Telephone Number	:	305-335-6468

Provider Enumeration Date	:	08/24/2014
Last Update Date	:	08/24/2014

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Directions to “BRIGHT MINDS THERAPY LLC ” Practice Location

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