Healthcare Provider Details

I. General information

NPI: 1124819313
Provider Name (Legal Business Name): SHINE CAMPUS FAMILY COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 08/06/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N HALL ST STE B
VISALIA CA
93291-4639
US

IV. Provider business mailing address

1125 S SOWELL ST
VISALIA CA
93277-2440
US

V. Phone/Fax

Practice location:
  • Phone: 559-657-6167
  • Fax: 559-236-0410
Mailing address:
  • Phone: 559-667-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRISELDA S VALENCIA
Title or Position: OWNER
Credential: LMFT
Phone: 559-667-7387