Provider Demographics
NPI:1174949937
Name:BRILLIANT SKY COUNSELING, PLLC
Entity type:Organization
Organization Name:BRILLIANT SKY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LORAINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:602-753-6841
Mailing Address - Street 1:5936 E FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-5566
Mailing Address - Country:US
Mailing Address - Phone:480-641-1382
Mailing Address - Fax:
Practice Address - Street 1:2929 N POWER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1745
Practice Address - Country:US
Practice Address - Phone:602-753-6841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13954251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health