Healthcare Provider Details

I. General information

NPI: 1386437911
Provider Name (Legal Business Name): SHINE ON COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5272 S LEWIS AVE STE 110
TULSA OK
74105-6563
US

IV. Provider business mailing address

5272 S LEWIS AVE STE 110
TULSA OK
74105-6563
US

V. Phone/Fax

Practice location:
  • Phone: 918-770-9857
  • Fax:
Mailing address:
  • Phone: 918-770-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JADEA ALACIA MILLER
Title or Position: THERAPIST
Credential: LPC
Phone: 918-770-9857