Healthcare Provider Details

I. General information

NPI: 1609781400
Provider Name (Legal Business Name): THE BRIGHTER SIDE OF LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 CACTUS WREN CT
SAINT AUGUSTINE FL
32084-8262
US

IV. Provider business mailing address

2512 CACTUS WREN CT
SAINT AUGUSTINE FL
32084-8262
US

V. Phone/Fax

Practice location:
  • Phone: 814-242-0692
  • Fax:
Mailing address:
  • Phone: 814-242-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL J AYRES
Title or Position: OWNER
Credential: LCSW
Phone: 814-242-0692