Provider Demographics
NPI:1831441377
Name:BRIGHT SIDE COUNSELING, LLC
Entity type:Organization
Organization Name:BRIGHT SIDE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST/SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ATR, LPC
Authorized Official - Phone:860-338-6706
Mailing Address - Street 1:122A NAUBUC AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4246
Mailing Address - Country:US
Mailing Address - Phone:860-338-6706
Mailing Address - Fax:
Practice Address - Street 1:122A NAUBUC AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4246
Practice Address - Country:US
Practice Address - Phone:860-338-6706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001617261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center