Provider Demographics
NPI:1689182875
Name:SHINING STAR THERAPY LLC
Entity Type:Organization
Organization Name:SHINING STAR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:DIEMERT
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:724-875-4946
Mailing Address - Street 1:123 FLOUR BAG FORT LN
Mailing Address - Street 2:
Mailing Address - City:CLARIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15623-1938
Mailing Address - Country:US
Mailing Address - Phone:724-875-4946
Mailing Address - Fax:724-744-4275
Practice Address - Street 1:56 SHERATON DR STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7555
Practice Address - Country:US
Practice Address - Phone:724-875-4946
Practice Address - Fax:724-420-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW017704251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health