Provider Demographics
NPI:1891156097
Name:BRIGHTSIDE BEHAVIORAL LLC
Entity type:Organization
Organization Name:BRIGHTSIDE BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC-S
Authorized Official - Phone:225-405-5861
Mailing Address - Street 1:1651 LOBDELL AVENUE SUITE 203-B
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-405-5861
Mailing Address - Fax:800-570-9169
Practice Address - Street 1:1651 LOBDELL AVENUE SUITE 203-B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-405-5861
Practice Address - Fax:800-570-9169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health