Provider Demographics
NPI:1356797344
Name:SHINE BRIGHT FAMILY SERVICES
Entity type:Organization
Organization Name:SHINE BRIGHT FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNICA
Authorized Official - Middle Name:CARMELL
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-822-2262
Mailing Address - Street 1:1205 S. AIR DEPOT
Mailing Address - Street 2:SUITE 317
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110
Mailing Address - Country:US
Mailing Address - Phone:405-822-2262
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 216
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4525
Practice Address - Country:US
Practice Address - Phone:405-822-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty