Basic Information
| Provider Information | |||||||||
| NPI: | 1023524709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIGHT | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 E GORDON AVE STE 4 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840412375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 8015135608 | ||||||||
| Practice Location | |||||||||
| Address1: | 1438 N HIGHWAY 89 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840252944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012000645 | ||||||||
| FaxNumber: | 8015135608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2017 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 7546534-2506 | UT | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 7546534-2507 | UT | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 101YM0800X | 7546534-6004 | UT | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.