Provider Demographics
NPI:1285072504
Name:BRIGHT FUTURES SPEECH THERAPY
Entity type:Organization
Organization Name:BRIGHT FUTURES SPEECH THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AJA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS SLP
Authorized Official - Phone:831-309-2101
Mailing Address - Street 1:628 HIGHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9005
Mailing Address - Country:US
Mailing Address - Phone:831-309-2101
Mailing Address - Fax:877-215-7951
Practice Address - Street 1:628 HIGHWOOD CIR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-9005
Practice Address - Country:US
Practice Address - Phone:831-309-2101
Practice Address - Fax:877-215-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-09
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA10343OtherLICENSE NUMBER
FL004872000Medicaid