Provider Demographics
NPI:1366882086
Name:BRILLIANT FUTURES, LLC
Entity type:Organization
Organization Name:BRILLIANT FUTURES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVA
Authorized Official - Middle Name:
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-631-4673
Mailing Address - Street 1:396 E SOUTHWEST PKWY
Mailing Address - Street 2:824
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6391
Mailing Address - Country:US
Mailing Address - Phone:469-631-4673
Mailing Address - Fax:
Practice Address - Street 1:396 E SOUTHWEST PKWY
Practice Address - Street 2:824
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6391
Practice Address - Country:US
Practice Address - Phone:469-631-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty