=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821976713
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHINE BEHAVIORAL HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2581 WASHINGTON RD STE 230J
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15241-2564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-444-5186
-----------------------------------------------------
Fax | 412-483-1811
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 CHEROKEE RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15241-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-498-8747
-----------------------------------------------------
Fax | 412-483-1811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JOANNE ASTA PETURSSON
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 412-498-8747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------