Provider Demographics
NPI:1982438560
Name:BRIGHT, NICOLE (MS, NCSP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:MS, NCSP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:WEEKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:471 SW BELAIR DR
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-7415
Mailing Address - Country:US
Mailing Address - Phone:971-200-0155
Mailing Address - Fax:
Practice Address - Street 1:471 SW BELAIR DR
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016-7415
Practice Address - Country:US
Practice Address - Phone:971-200-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR135159103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool