Provider Demographics
NPI:1467282251
Name:BRIGHT, ELIZABETH LISA MARGARET (BS, QIDP)
Entity type:Individual
Prefix:
First Name:ELIZABETH LISA
Middle Name:MARGARET
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:BS, QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22450 PARK ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2730
Mailing Address - Country:US
Mailing Address - Phone:313-562-1787
Mailing Address - Fax:
Practice Address - Street 1:22450 PARK ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2730
Practice Address - Country:US
Practice Address - Phone:313-562-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services