NPIMap

Organization Active NPI

Bright Clinic

Doing business as Brightside Clinic

  • Mental Health Counselor
  • Denham Springs, LA
National Provider Identifier
1275104473
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
BRIGHT CLINIC
Doing business as
Brightside Clinic
Practice address
106 Business Park Avenue
Denham Springs, LA 70726
Phone
(225) 921-5392
NPI assigned
Jul 8, 2021
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Evon RoquemoreNPI 1912435546
Title
Ceo
Phone
(888) 417-5250

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Mental Health Counselor 101YM0800X Primary
Professional Counselor 101YP2500X
Clinical Social Worker 1041C0700X
Psychiatry Physician 2084P0800X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

106 Business Park Avenue
Denham Springs, LA 70726

Mailing address

106 Business Park Avenue
Denham Springs, LA 70726

Other names 1

  • Brightside Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240822000372 LA Part B Supplier - Clinic/Group Practice 8921547936 Receives reassigned benefits from 1 practitioner
Practice locations: Denham Springs, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 103

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 103

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1275104473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 BUSINESS PARK AVENUE",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "70726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BUSINESS PARK AVENUE",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "70726",
            "telephone_number": "225-921-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGHT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-08",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "ROQUEMORE",
        "authorized_official_first_name": "EVON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "888-417-5250"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brightside Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brightside Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Denham Springs, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.