Provider Demographics
NPI:1265016679
Name:BRIGHTSIDE COWORKING INC
Entity Type:Organization
Organization Name:BRIGHTSIDE COWORKING INC
Other - Org Name:LUMINESCE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SCHUCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:503-754-2636
Mailing Address - Street 1:624 SE 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2126
Mailing Address - Country:US
Mailing Address - Phone:503-382-9506
Mailing Address - Fax:
Practice Address - Street 1:6018 SE STARK ST STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1990
Practice Address - Country:US
Practice Address - Phone:503-206-5405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty