Provider Demographics
NPI:1386510378
Name:BRIGHTSTAR BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BRIGHTSTAR BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PIUS
Authorized Official - Middle Name:AWANDEM
Authorized Official - Last Name:TANYIFOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, APRN,
Authorized Official - Phone:763-291-3169
Mailing Address - Street 1:7722 MACKENZIE AVE NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-5031
Mailing Address - Country:US
Mailing Address - Phone:763-291-3169
Mailing Address - Fax:763-291-3169
Practice Address - Street 1:7420 UNITY AVE N STE 305
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3136
Practice Address - Country:US
Practice Address - Phone:763-291-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty