Provider Demographics
NPI:1588200091
Name:BRIGHT MIND LLC
Entity Type:Organization
Organization Name:BRIGHT MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KREUTZER
Authorized Official - Last Name:ERBER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:541-717-3033
Mailing Address - Street 1:121 NW BOND ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-3207
Mailing Address - Country:US
Mailing Address - Phone:206-225-8780
Mailing Address - Fax:
Practice Address - Street 1:151 SW SHEVLIN HIXON DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3209
Practice Address - Country:US
Practice Address - Phone:541-717-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1235449463OtherNPI- TODD BOIRE
WA1558689836OtherNPI - AMY ERBER