| Brink Of Brilliance, Llc | |
|
555 Main St Springfield OR 97477-5470 | |
| (541) 393-6452 | |
| Not Available |
| Full Name | Brink Of Brilliance, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 555 Main St, Springfield, Oregon |
| Authorized Official Name and Position | Denise R Gaudette (OWNER) |
| Authorized Official Contact | 5413936452 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brink Of Brilliance, Llc Po Box 1401 Springfield OR 97477-0159 Ph: (541) 393-6452 | Brink Of Brilliance, Llc 555 Main St Springfield OR 97477-5470 Ph: (541) 393-6452 |
| NPI Number | 1558972000 |
|---|---|
| Provider Enumeration Date | 08/10/2020 |
| Last Update Date | 08/10/2020 |
| Certification Date | 08/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558972000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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