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General NPI Number Information
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NPI Number | 1497306450
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Entity Type | Organization
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Legal Business Name | BRIGHT SPACE THERAPY
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Dates
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Enumeration Date | 09/21/2019
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Last Update Date | 09/21/2019
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Provider Practice Location Address
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Address Line | 100 CRESCENT CT STE 700
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City | DALLAS
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State | TX
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Zip | 75201-2112
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Country | US
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Telephone | 214-444-3649
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Fax |
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Provider Business Mailing Address
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Address Line | 2221 CREEKSIDE CIR N
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City | IRVING
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State | TX
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Zip | 75063-3346
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Country | US
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Telephone | 214-444-3649
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Fax |
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | KATHERINE LOGAN NIX
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Credential | MA LPC
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Telephone | 214-444-3649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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