Provider Demographics
NPI:1457730194
Name:BRIGHTSIDE COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:BRIGHTSIDE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-257-1752
Mailing Address - Street 1:4810 S BAHAMA WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4917
Mailing Address - Country:US
Mailing Address - Phone:303-353-9226
Mailing Address - Fax:720-923-2321
Practice Address - Street 1:5650 GREENWOOD PLAZA BLVD STE 144-145
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2307
Practice Address - Country:US
Practice Address - Phone:303-353-9226
Practice Address - Fax:720-923-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11693101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000174335Medicaid