Provider Demographics
NPI:1497330989
Name:SHINE COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:SHINE COUNSELING AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-688-2896
Mailing Address - Street 1:PO BOX 271675
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1675
Mailing Address - Country:US
Mailing Address - Phone:361-688-2896
Mailing Address - Fax:
Practice Address - Street 1:5151 FLYNN PKWY STE 506
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4392
Practice Address - Country:US
Practice Address - Phone:361-688-2896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty