Provider Demographics
NPI:1952097222
Name:BRIGHT MINDS BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:BRIGHT MINDS BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDEFUR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA
Authorized Official - Phone:423-341-7320
Mailing Address - Street 1:24160 WALDEN RD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-7714
Mailing Address - Country:US
Mailing Address - Phone:423-341-7320
Mailing Address - Fax:
Practice Address - Street 1:24160 WALDEN RD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-7714
Practice Address - Country:US
Practice Address - Phone:423-341-7320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty