Provider Demographics
NPI:1629653738
Name:EARTHSHINE COUNSELING, LLC
Entity Type:Organization
Organization Name:EARTHSHINE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PANAHINIA
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:385-800-1818
Mailing Address - Street 1:2460 E CAMINO WAY
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-4004
Mailing Address - Country:US
Mailing Address - Phone:801-414-5786
Mailing Address - Fax:
Practice Address - Street 1:7050 S HIGHLAND DR STE 120
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3749
Practice Address - Country:US
Practice Address - Phone:385-800-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty