Provider Demographics
NPI:1124779111
Name:BRIGHTER MINDS THERAPY
Entity type:Organization
Organization Name:BRIGHTER MINDS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KIMBREL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-295-9626
Mailing Address - Street 1:4721 BRIANS WAY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4490
Mailing Address - Country:US
Mailing Address - Phone:720-295-9626
Mailing Address - Fax:303-265-9416
Practice Address - Street 1:4721 BRIANS WAY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-4490
Practice Address - Country:US
Practice Address - Phone:720-295-9626
Practice Address - Fax:303-265-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1871979534OtherINDIVIDUAL NPI