Provider Demographics
NPI:1831567452
Name:BRIGHT LIGHT COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:BRIGHT LIGHT COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARNIX
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-600-7674
Mailing Address - Street 1:30 N MICHIGAN AVE STE 515
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3830
Mailing Address - Country:US
Mailing Address - Phone:312-600-7674
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 515
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3830
Practice Address - Country:US
Practice Address - Phone:312-600-7674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty