MEDICARE: BRIGHT BEHAVIOR 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1730609751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT BEHAVIOR THERAPY LLC

Provider Business Mailing Address
First Line	:	27247 KINGSWOOD DR
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-3361
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23500 PARK ST STE 3
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2598
Country	:	US
Telephone Number	:	313-645-2422
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	SONIA SALMAN
Credential	:
Telephone Number	:	313-645-2422

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	11/10/2023

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