MEDICARE: SHINING LIGHT COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1194403097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINING LIGHT COUNSELING LLC

Provider Business Mailing Address
First Line	:	2843 TALBOT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-1690
Country	:	US
Telephone Number	:	412-712-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	2843 TALBOT ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-1690
Country	:	US
Telephone Number	:	412-712-2294
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PROFESSIONAL COUNSELOR
Name	:	MS. SARAH ELLEN MAYS
Credential	:	CPC
Telephone Number	:	412-712-2294

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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