Provider Demographics
NPI:1053874990
Name:BRIGHT LIFE COUNSELING
Entity type:Organization
Organization Name:BRIGHT LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-263-0047
Mailing Address - Street 1:1011 MERCURY DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2771
Mailing Address - Country:US
Mailing Address - Phone:720-490-6730
Mailing Address - Fax:
Practice Address - Street 1:1011 MERCURY DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2771
Practice Address - Country:US
Practice Address - Phone:720-263-0047
Practice Address - Fax:720-306-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000172052Medicaid