Provider Demographics
NPI:1790361079
Name:BRIGHTLIFE COUNSELING, LLC
Entity Type:Organization
Organization Name:BRIGHTLIFE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-791-9192
Mailing Address - Street 1:401 S 1350 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8126
Mailing Address - Country:US
Mailing Address - Phone:801-791-9192
Mailing Address - Fax:
Practice Address - Street 1:1513 N HILL FIELD RD STE 1-5
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2162
Practice Address - Country:US
Practice Address - Phone:385-424-0175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty