Provider Demographics
NPI:1336747583
Name:SHINE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:SHINE PSYCHOTHERAPY
Other - Org Name:GILA LEHAVI BROWN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-497-7461
Mailing Address - Street 1:6310 SAN VICENTE BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5446
Mailing Address - Country:US
Mailing Address - Phone:310-497-7461
Mailing Address - Fax:
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 425
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5446
Practice Address - Country:US
Practice Address - Phone:310-626-4427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-10
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty