1932772415 NPI number — BRIGHTSIDE COUNSELING

Table of content: (NPI 1932772415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932772415 NPI number — BRIGHTSIDE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHTSIDE COUNSELING
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:
1932772415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
943 N 100 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURRICANE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84737-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-767-7957
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 W FIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILDALE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84784-7798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-767-7957
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CANDLAND
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
LMFT/OWNER
Authorized Official Telephone Number:
435-767-7957

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1831589019 . This is a "TYPE 1 NPI NUMBER" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com