Provider Demographics
NPI:1619177797
Name:BRIGHT TOMORROWS CHILD ADVOCACY CENTER
Entity Type:Organization
Organization Name:BRIGHT TOMORROWS CHILD ADVOCACY CENTER
Other - Org Name:BRIGHT TOMORROWS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-234-2646
Mailing Address - Street 1:409 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4520
Mailing Address - Country:US
Mailing Address - Phone:208-234-2646
Mailing Address - Fax:208-232-0035
Practice Address - Street 1:409 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4520
Practice Address - Country:US
Practice Address - Phone:208-234-2646
Practice Address - Fax:208-232-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 870/LCPC 724101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8082288Medicaid