Healthcare Provider Details

I. General information

NPI: 1265183289
Provider Name (Legal Business Name): SHINE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 SOFTWIND PT
CASTLE ROCK CO
80108
US

IV. Provider business mailing address

3350 SOFTWIND PT
CASTLE ROCK CO
80108
US

V. Phone/Fax

Practice location:
  • Phone: 303-957-6097
  • Fax:
Mailing address:
  • Phone: 303-957-6097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KARA KNOX
Title or Position: COUNSELOR
Credential: LPC, BCBA
Phone: 303-957-6097