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General NPI Number Information
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NPI Number | 1629653738
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Entity Type | Organization
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Legal Business Name | EARTHSHINE COUNSELING, LLC
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 7050 S HIGHLAND DR STE 120
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-3749
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Country | US
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Telephone | 385-800-1818
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 E CAMINO WAY
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-4004
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Country | US
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Telephone | 801-414-5786
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JENNIFER PANAHINIA
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Credential | CMHC
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Telephone | 385-800-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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