Provider Demographics
NPI:1972714087
Name:BRIGHT HORIZONS PSYCHOLOGICAL CENTER
Entity Type:Organization
Organization Name:BRIGHT HORIZONS PSYCHOLOGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:810-720-5990
Mailing Address - Street 1:5370 MILLER RD STE 33
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1543
Mailing Address - Country:US
Mailing Address - Phone:810-720-5990
Mailing Address - Fax:
Practice Address - Street 1:5370 MILLER RD STE 33
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1543
Practice Address - Country:US
Practice Address - Phone:810-720-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011123251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health