1730909896 NPI number — BRIGHTER DAYS MENTAL HEALTH PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730909896 NPI number — BRIGHTER DAYS MENTAL HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTER DAYS MENTAL HEALTH PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730909896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62411-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-214-4990
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716A E 1700 AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANDALIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62471-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-214-4990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2024

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
AMBER
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
618-214-4990

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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