Provider Demographics
NPI:1295408425
Name:BRILLIANT FUTURES LLC
Entity type:Organization
Organization Name:BRILLIANT FUTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-772-4664
Mailing Address - Street 1:2005 GREENWAY ST APT A
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-1261
Mailing Address - Country:US
Mailing Address - Phone:214-772-4664
Mailing Address - Fax:
Practice Address - Street 1:126 NELSONS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:VA
Practice Address - Zip Code:23069-2530
Practice Address - Country:US
Practice Address - Phone:214-772-4664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-24
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty