Provider Demographics
NPI:1073139903
Name:SHINE COUNSELING, LLC
Entity Type:Organization
Organization Name:SHINE COUNSELING, LLC
Other - Org Name:EDIFY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER, CEO, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALKIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MC, LPC, NCC
Authorized Official - Phone:541-600-2300
Mailing Address - Street 1:2295 COBURG RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7489
Mailing Address - Country:US
Mailing Address - Phone:540-600-2300
Mailing Address - Fax:541-600-2324
Practice Address - Street 1:2295 COBURG RD STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7489
Practice Address - Country:US
Practice Address - Phone:541-600-2300
Practice Address - Fax:541-600-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)