Healthcare Provider Details

I. General information

NPI: 1417645557
Provider Name (Legal Business Name): BRIGHT SPACE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 LAKE PLAZA DR STE A
COLORADO SPRINGS CO
80906-7400
US

IV. Provider business mailing address

1611 S MURRAY BLVD
COLORADO SPRINGS CO
80916-4502
US

V. Phone/Fax

Practice location:
  • Phone: 719-645-5637
  • Fax:
Mailing address:
  • Phone: 719-645-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIA DEL PILAR BERGER
Title or Position: OWNER
Credential:
Phone: 719-645-5637