Provider Demographics
NPI:1790316230
Name:BRIGHT SIDE PROFESSIONAL SERVICES, PLLC
Entity Type:Organization
Organization Name:BRIGHT SIDE PROFESSIONAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRISENO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:469-271-8330
Mailing Address - Street 1:3015 MEDLIN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2360
Mailing Address - Country:US
Mailing Address - Phone:469-271-8330
Mailing Address - Fax:
Practice Address - Street 1:3015 MEDLIN DR STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2360
Practice Address - Country:US
Practice Address - Phone:469-271-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty