Healthcare Provider Details

I. General information

NPI: 1033717624
Provider Name (Legal Business Name): THERAPY TO SHINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 6TH AVE
JUNCTION CITY OR
97448
US

IV. Provider business mailing address

30131 SUBSTATION DR
HARRISBURG OR
97446-9702
US

V. Phone/Fax

Practice location:
  • Phone: 541-556-3850
  • Fax:
Mailing address:
  • Phone: 541-556-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/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: DEBRA HARGETT
Title or Position: THERAPIST
Credential: LCSW
Phone: 541-556-3850