Organization · NPI-2

Brightside Wellness LLC

Clinic/Center, Multi-Specialty · Peoria, AZ

NPI number1922718196
StatusActive
Last updated in NPPESJun 30, 2023

Details

NPI
1922718196
Entity type
Organization (NPI-2)
Legal business name
Brightside Wellness LLC
Organization subpart
No
Enumeration date
Nov 29, 2022
Certification date
Jun 30, 2023
Last updated
Jun 30, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM1300X Clinic/Center, Multi-Specialty––Yes
101YA0400X Counselor, Addiction (Substance Use Disorder)––
101YM0800X Counselor, Mental Health––
103TA0400X Psychologist, Addiction (Substance Use Disorder)––
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––
363L00000X Nurse Practitioner––
363LP0808X Nurse Practitioner, Psych/Mental Health––

Practice location

7100 W Grandview Rd
#1126
Peoria, AZ 85382-4911

Phone 602-708-9253

Mailing address

7100 W Grandview Rd Apt 1126
Peoria, AZ 85382-4911

Phone 602-708-9253

Authorized official

Cindy Jeptoo Bett
Owner
6027089253

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