1740737311 NPI number — BRIGHT LIGHT COUNSELING SERVICES

Table of content: TINA KATHERINE STURGEON NP (NPI 1407322472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740737311 NPI number — BRIGHT LIGHT COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT LIGHT COUNSELING SERVICES
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:
1740737311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 HUMOLDT AVE SOUTH
Provider Second Line Business Mailing Address:
301
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-283-4745
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 HUMBOLDT AVE S
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-283-4745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HIRSI
Authorized Official First Name:
ABDIAZIZ
Authorized Official Middle Name:
HASSAN
Authorized Official Title or Position:
CEO AND PRESIDENT
Authorized Official Telephone Number:
651-283-4745

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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