=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558765008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHTSIDE COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2014
-----------------------------------------------------
Last Update Date | 10/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4337 E SAM HOUSTON PKWY N
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77015-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-453-6358
-----------------------------------------------------
Fax | 713-453-6305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4337 E SAM HOUSTON PKWY N
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77015-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-453-6358
-----------------------------------------------------
Fax | 713-453-6305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KAREN HIMELFARB
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 713-453-6358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 201055
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------