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General NPI Number Information
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NPI Number | 1356797344
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Entity Type | Organization
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Legal Business Name | SHINE BRIGHT FAMILY SERVICES
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 5350 S WESTERN AVE STE 216
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City | OKLAHOMA CITY
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State | OK
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Zip | 73109-4525
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Country | US
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Telephone | 405-822-2262
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 S. AIR DEPOT SUITE 317
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City | MIDWEST CITY
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State | OK
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Zip | 73110
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Country | US
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Telephone | 405-822-2262
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | SHAUNICA CARMELL BYRD
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Credential | LPC
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Telephone | 405-822-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6039
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License Number State | OK
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