Provider Demographics
NPI:1588836464
Name:BRIGHT, JEFFREY THOMAS (EDS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JERRY BURTON DRIVE
Mailing Address - Street 2:BCHS
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601
Mailing Address - Country:US
Mailing Address - Phone:304-765-2909
Mailing Address - Fax:304-765-7976
Practice Address - Street 1:411 NORTH HILL ROAD
Practice Address - Street 2:BRAXTON COUNTY BOARD OF EDUCATION
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601
Practice Address - Country:US
Practice Address - Phone:304-765-7101
Practice Address - Fax:304-765-7148
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21017103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist