Healthcare Provider Details

I. General information

NPI: 1255969713
Provider Name (Legal Business Name): SHINE BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 BENFIELD RD STE A
SEVERNA PARK MD
21146-2523
US

IV. Provider business mailing address

541 BENFIELD RD STE A
SEVERNA PARK MD
21146-2523
US

V. Phone/Fax

Practice location:
  • Phone: 410-513-4513
  • Fax: 866-697-4991
Mailing address:
  • Phone: 410-513-4513
  • Fax: 866-697-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY CALLAHAN
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential:
Phone: 410-513-4513