Provider Demographics
NPI:1437561313
Name:SHINES, ELAINE RACHAEL
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:RACHAEL
Last Name:SHINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BERMUDA LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-3352
Mailing Address - Country:US
Mailing Address - Phone:502-762-5237
Mailing Address - Fax:
Practice Address - Street 1:207 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2585
Practice Address - Country:US
Practice Address - Phone:270-756-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health