MEDICARE: BRIGHT SPACE COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1417645557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT SPACE COUNSELING

Provider Business Mailing Address
First Line	:	1611 S MURRAY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80916-4502
Country	:	US
Telephone Number	:	719-645-5637
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 LAKE PLAZA DR STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7400
Country	:	US
Telephone Number	:	719-645-5637
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA DEL PILAR BERGER
Credential	:
Telephone Number	:	719-645-5637

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	10/02/2024

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Directions to “BRIGHT SPACE COUNSELING ” Practice Location

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