Provider Demographics
NPI:1639764541
Name:SHINE BRIGHT BEHAVIORAL HEALTH, L.L.C.
Entity Type:Organization
Organization Name:SHINE BRIGHT BEHAVIORAL HEALTH, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:FAYRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-400-1888
Mailing Address - Street 1:800 N RAINBOW BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1190
Mailing Address - Country:US
Mailing Address - Phone:702-374-6792
Mailing Address - Fax:
Practice Address - Street 1:5020 ALTA DR STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3940
Practice Address - Country:US
Practice Address - Phone:725-400-1888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty