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General NPI Number Information
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NPI Number | 1649713967
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Entity Type | Organization
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Legal Business Name | SHINE PSYCHOLOGICAL TESTING & ASSESSMENT SERVICES
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Dates
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Enumeration Date | 11/18/2016
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 3405 MILTON AVE
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City | DALLAS
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State | TX
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Zip | 75205-5602
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Country | US
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Telephone | 214-530-2337
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Fax |
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Provider Business Mailing Address
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Address Line | 12424 OCEAN SPRAY DR
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City | FRISCO
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State | TX
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Zip | 75034-0341
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER MAUPIN
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Credential | M.A., LPC-S
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Telephone | 214-530-2337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 65173
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License Number State | TX
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