Provider Demographics
NPI:1770208167
Name:DIVINE SHYNE THERAPY, P.L.L.C.
Entity type:Organization
Organization Name:DIVINE SHYNE THERAPY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMALA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:316-210-7914
Mailing Address - Street 1:PO BOX 31614
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80041-0614
Mailing Address - Country:US
Mailing Address - Phone:316-210-7914
Mailing Address - Fax:720-392-9846
Practice Address - Street 1:2000 S COLORADO BLVD, TOWER 1
Practice Address - Street 2:SUITE 2000-520
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-0000
Practice Address - Country:US
Practice Address - Phone:720-392-9846
Practice Address - Fax:720-392-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health