Provider Demographics
NPI:1265174494
Name:SHINE COUNSELING TAMPA
Entity type:Organization
Organization Name:SHINE COUNSELING TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-444-3658
Mailing Address - Street 1:4100 W KENNEDY BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2244
Mailing Address - Country:US
Mailing Address - Phone:813-444-3658
Mailing Address - Fax:
Practice Address - Street 1:209 W HAYA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2034
Practice Address - Country:US
Practice Address - Phone:813-444-3658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty