Provider Demographics
NPI:1215316807
Name:BRIGHT START EARLY INTERVENTION, LLC
Entity type:Organization
Organization Name:BRIGHT START EARLY INTERVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LISCENSED BEHAVIOR ANALYSIS IN KY
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:CAITLIN
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA, MED
Authorized Official - Phone:270-860-9594
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-0066
Mailing Address - Country:US
Mailing Address - Phone:270-860-9594
Mailing Address - Fax:270-458-0022
Practice Address - Street 1:121 1/2 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42419-0066
Practice Address - Country:US
Practice Address - Phone:270-860-9594
Practice Address - Fax:270-458-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1004103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty