Provider Demographics
NPI:1861730269
Name:BRIGHT HORIZONS COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:BRIGHT HORIZONS COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:203-435-1366
Mailing Address - Street 1:19 SHAWMUT AVE REAR
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2660
Mailing Address - Country:US
Mailing Address - Phone:203-234-0147
Mailing Address - Fax:
Practice Address - Street 1:19 SHAWMUT AVE REAR
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2660
Practice Address - Country:US
Practice Address - Phone:203-234-0147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000951101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty