Provider Demographics
NPI:1659993228
Name:BRIGHT LIGHT COUNSELING, P.C.
Entity Type:Organization
Organization Name:BRIGHT LIGHT COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEBEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, RPT-S
Authorized Official - Phone:515-992-6355
Mailing Address - Street 1:6165 NW 86TH ST # 127
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2270
Mailing Address - Country:US
Mailing Address - Phone:515-992-6355
Mailing Address - Fax:
Practice Address - Street 1:6165 NW 86TH ST # 127
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2270
Practice Address - Country:US
Practice Address - Phone:515-992-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215220223OtherINDIVIDUAL NPI