Provider Demographics
NPI:1922518547
Name:BRIGHTER PATH COUNSELING SERVICES, INC.
Entity type:Organization
Organization Name:BRIGHTER PATH COUNSELING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PANAMENO CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:909-782-8382
Mailing Address - Street 1:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92334-1176
Mailing Address - Country:US
Mailing Address - Phone:909-782-8382
Mailing Address - Fax:909-365-3576
Practice Address - Street 1:7828 HAVEN AVE STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3049
Practice Address - Country:US
Practice Address - Phone:909-782-8382
Practice Address - Fax:909-365-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261271041C0700X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty