Provider Demographics
NPI:1417661380
Name:SHINE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:SHINE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUI
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:424-234-2924
Mailing Address - Street 1:3813 CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2852
Mailing Address - Country:US
Mailing Address - Phone:657-377-5522
Mailing Address - Fax:801-807-0327
Practice Address - Street 1:5300 TOWN AND COUNTRY BLVD STE 240
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-6894
Practice Address - Country:US
Practice Address - Phone:657-377-5522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty