Provider Demographics
NPI:1154185981
Name:BRIGHTMIND WELLNESS PLLC
Entity type:Organization
Organization Name:BRIGHTMIND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-997-2099
Mailing Address - Street 1:2225 SYCAMORE ST STE 1210
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-1026
Mailing Address - Country:US
Mailing Address - Phone:813-997-2099
Mailing Address - Fax:
Practice Address - Street 1:2225 SYCAMORE ST STE 1210
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1026
Practice Address - Country:US
Practice Address - Phone:813-997-2099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty