MEDICARE: BRIGHT IMPACT BEHAVIORAL PRACTICE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1932075942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT IMPACT BEHAVIORAL PRACTICE

Provider Business Mailing Address
First Line	:	1012 GA HIGHWAY 247 S
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-2349
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 GA HIGHWAY 247 S
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-2349
Country	:	US
Telephone Number	:	943-200-0016
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL DIRECTOR
Name	:	STACYANN SAMUELS
Credential	:
Telephone Number	:	943-200-0016

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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