Provider Demographics
NPI:1740737311
Name:BRIGHT LIGHT COUNSELING SERVICES
Entity Type:Organization
Organization Name:BRIGHT LIGHT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDIAZIZ
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:HIRSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-283-4745
Mailing Address - Street 1:8200 HUMOLDT AVE SOUTH
Mailing Address - Street 2:301
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431
Mailing Address - Country:US
Mailing Address - Phone:651-283-4745
Mailing Address - Fax:
Practice Address - Street 1:8200 HUMBOLDT AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1433
Practice Address - Country:US
Practice Address - Phone:651-283-4745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health