Provider Demographics
NPI:1376601914
Name:BRIGHTER HEIGHTS ARIZONA, LLC
Entity type:Organization
Organization Name:BRIGHTER HEIGHTS ARIZONA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR CREDENTIALING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-772-4131
Mailing Address - Street 1:2517 N GREAT WESTERN DR STE P
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2597
Mailing Address - Country:US
Mailing Address - Phone:928-777-4131
Mailing Address - Fax:928-227-4589
Practice Address - Street 1:2517 N GREAT WESTERN DR STE P
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2597
Practice Address - Country:US
Practice Address - Phone:928-777-4131
Practice Address - Fax:928-227-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2730101YM0800X
AZBH-3517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210064Medicaid
AZ157612OtherAHCCCS ID