Provider Demographics
NPI:1023859352
Name:BRIGHT AURA THERAPY AND WELLNESS
Entity type:Organization
Organization Name:BRIGHT AURA THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:FRIDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-437-2197
Mailing Address - Street 1:10188 76TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:MI
Mailing Address - Zip Code:49302-9640
Mailing Address - Country:US
Mailing Address - Phone:616-437-2197
Mailing Address - Fax:
Practice Address - Street 1:2040 RAYBROOK ST SE STE 302
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7718
Practice Address - Country:US
Practice Address - Phone:616-437-2197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty