Provider Demographics
NPI:1740687177
Name:LET YOUR SOUL SHINE COUNSELING, PLLC
Entity type:Organization
Organization Name:LET YOUR SOUL SHINE COUNSELING, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC
Authorized Official - Phone:469-231-6822
Mailing Address - Street 1:2901 CORPORATE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2284
Mailing Address - Country:US
Mailing Address - Phone:469-231-6822
Mailing Address - Fax:
Practice Address - Street 1:2901 CORPORATE CIR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2284
Practice Address - Country:US
Practice Address - Phone:469-231-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68657101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty