MEDICARE: BRIGHTER PATH COUNSELING SERVICES, INC.

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	1041C0700X	Clinical Social Worker	26127	CA
2	101YM0800X	Mental Health Counselor		CA

General Provider Information

NPI Number	:	1922518547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER PATH COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1176
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92334-1176
Country	:	US
Telephone Number	:	909-782-8382
Fax Number	:	909-365-3576

Provider Business Practice Location Address
First Line	:	7828 HAVEN AVE STE 102
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-3049
Country	:	US
Telephone Number	:	909-782-8382
Fax Number	:	909-365-3576

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JAVIER MARTIN PANAMENO CAMPOS
Credential	:	LCSW
Telephone Number	:	909-782-8382

Provider Enumeration Date	:	10/10/2017
Last Update Date	:	10/10/2017

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