Provider Demographics
NPI:1235552787
Name:BRIGHT PSYCHE PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:BRIGHT PSYCHE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:BRIGHT PSYCHE PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-495-8347
Mailing Address - Street 1:710 OAKFIELD DR STE 223
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4954
Mailing Address - Country:US
Mailing Address - Phone:813-419-3137
Mailing Address - Fax:877-599-4198
Practice Address - Street 1:710 OAKFIELD DR STE 223
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4954
Practice Address - Country:US
Practice Address - Phone:813-419-3137
Practice Address - Fax:877-599-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X, 261QM0855X
FLPY8347251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health