Healthcare Provider Details

I. General information

NPI: 1376244715
Provider Name (Legal Business Name): BRIGHTSIDE PROFESSIONAL CLINICAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 CAMINO DEL RIO S STE 215
SAN DIEGO CA
92108-3510
US

IV. Provider business mailing address

444 CAMINO DEL RIO S STE 215
SAN DIEGO CA
92108-3510
US

V. Phone/Fax

Practice location:
  • Phone: 415-264-3343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHELSEA STERLING
Title or Position: OWNER, THERAPIST
Credential: LPCC
Phone: 415-264-3343