1073173175 NPI number — BRIGHT REFLECTIONS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073173175 NPI number — BRIGHT REFLECTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT REFLECTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073173175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 BROAD ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-5478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-221-7484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1602 BROAD ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-5478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-221-7484
Provider Business Practice Location Address Fax Number:
724-972-4207
Provider Enumeration Date:
06/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CLINE
Authorized Official First Name:
KRISTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/CLINICIAN
Authorized Official Telephone Number:
724-221-7484

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PC007629 . This is a "LICENSED PROFESSIONAL COUNSELOR LPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2738 . This is a "BC-TMH BOARD CERTIFIED TELEMENTAL HEALTH PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8912 . This is a "CERTIFIED ALCOHOL AND DRUG COUNSELOR CAADC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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