Healthcare Provider Details

I. General information

NPI: 1487414223
Provider Name (Legal Business Name): BRIGHT EYES COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 MONTGOMERY BLVD NE APT 2205
ALBUQUERQUE NM
87109-1559
US

IV. Provider business mailing address

7501 MONTGOMERY BLVD NE APT 2205
ALBUQUERQUE NM
87109-1559
US

V. Phone/Fax

Practice location:
  • Phone: 575-937-0772
  • Fax:
Mailing address:
  • Phone: 575-937-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER D LACKEY
Title or Position: OWNER
Credential: LPCC
Phone: 575-937-0772