Provider Demographics
NPI:1902152184
Name:BRIGHT, MISTY DAWN (LICSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 S 176TH ST UNIT 219
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-4038
Mailing Address - Country:US
Mailing Address - Phone:206-307-8432
Mailing Address - Fax:
Practice Address - Street 1:TRAVERSE THERAPY SERVICES, LLC
Practice Address - Street 2:12507 BEL-RED RD., STE. 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-9800
Practice Address - Country:US
Practice Address - Phone:206-307-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60148743101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor