MEDICARE: SHINE A LIGHT FAMILY THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1801755772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHINE A LIGHT FAMILY THERAPY, INC.

Provider Business Mailing Address
First Line	:	70 PENNY LN STE D
Second Line	:
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-6020
Country	:	US
Telephone Number	:	831-222-0111
Fax Number	:	831-417-0443

Provider Business Practice Location Address
First Line	:	70 PENNY LN STE D
Second Line	:
City	:	WATSONVILLE
State	:	CA
Zip	:	95076-6020
Country	:	US
Telephone Number	:	831-222-0111
Fax Number	:	831-417-0443

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY VINCENT HARTNETT
Credential	:	LMFT
Telephone Number	:	831-222-0111

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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