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General NPI Number Information
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NPI Number | 1285192336
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Entity Type | Organization
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Legal Business Name | BRIGHTSIDE THERAPY COLLECTIVE
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 3311 CAMP ST
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City | NEW ORLEANS
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State | LA
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Zip | 70115-2472
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Country | US
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Telephone | 504-264-2505
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 CANAL ST APT 418
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2665
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Country | US
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Telephone | 504-264-2505
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. AMANDA JOHNS
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Credential | PH.D., LPCS, NCC
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Telephone | 504-264-2505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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