Healthcare Provider Details

I. General information

NPI: 1689058349
Provider Name (Legal Business Name): SHINE A LIGHT COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 PENNY LN
WATSONVILLE CA
95076-6020
US

IV. Provider business mailing address

70 PENNY LN
WATSONVILLE CA
95076-6020
US

V. Phone/Fax

Practice location:
  • Phone: 831-996-1222
  • Fax: 831-417-0443
Mailing address:
  • Phone: 831-996-1222
  • Fax: 831-417-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: TIMOTHY VINCENT HARTNETT
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 831-222-0111