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NPI Code Detail

MEDICARE: LIGHT BRIGHT COUNSELING CENTER, PLLC

MEDICARE: LIGHT BRIGHT COUNSELING CENTER, PLLC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1891340386
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHT BRIGHT COUNSELING CENTER, PLLC
Provider Business Mailing Address
First Line : 10416 BOXTHORN CT
Second Line :
City : FORT WORTH
State : TX
Zip : 76177-3012
Country : US
Telephone Number : 817-675-1074
Fax Number : 682-708-0501
Provider Business Practice Location Address
First Line : 1751 RIVER RUN STE 200
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-6670
Country : US
Telephone Number : 682-253-6810
Fax Number :
Authorized Official
Title or Position : THERAPIST
Name : MS. CHERYL V. GRAY
Credential : LPC-SUPERVISOR
Telephone Number : 817-675-1074
Provider Enumeration Date : 08/02/2019
Last Update Date : 08/02/2019

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Directions to “LIGHT BRIGHT COUNSELING CENTER, PLLC ” Practice Location

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