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NPI Code Detail

MEDICARE: BRIGHT SPACE THERAPY

MEDICARE: BRIGHT SPACE THERAPY
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1497306450
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGHT SPACE THERAPY
Provider Business Mailing Address
First Line : 2221 CREEKSIDE CIR N
Second Line :
City : IRVING
State : TX
Zip : 75063-3346
Country : US
Telephone Number : 214-444-3649
Fax Number :
Provider Business Practice Location Address
First Line : 100 CRESCENT CT STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75201-2112
Country : US
Telephone Number : 214-444-3649
Fax Number :
Authorized Official
Title or Position : OWNER/COUNSELOR
Name : KATHERINE LOGAN NIX
Credential : MA LPC
Telephone Number : 214-444-3649
Provider Enumeration Date : 09/21/2019
Last Update Date : 09/21/2019

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Directions to “BRIGHT SPACE THERAPY ” Practice Location

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