Provider Demographics
NPI:1871281014
Name:BRIGHT MINDS INTERVENTIONS LLC
Entity type:Organization
Organization Name:BRIGHT MINDS INTERVENTIONS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COCEO
Authorized Official - Prefix:
Authorized Official - First Name:DEASY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:240-593-9908
Mailing Address - Street 1:4217 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2144
Mailing Address - Country:US
Mailing Address - Phone:240-593-9908
Mailing Address - Fax:
Practice Address - Street 1:4217 STAFFORD RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2144
Practice Address - Country:US
Practice Address - Phone:240-593-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty