Provider Demographics
NPI:1215634118
Name:BRIGHT LIGHT ABA PLLC
Entity type:Organization
Organization Name:BRIGHT LIGHT ABA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PAGONE-WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:936-252-2602
Mailing Address - Street 1:1703 BIG BEND DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7475
Mailing Address - Country:US
Mailing Address - Phone:936-252-2602
Mailing Address - Fax:
Practice Address - Street 1:1703 BIG BEND DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7475
Practice Address - Country:US
Practice Address - Phone:936-252-2602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty