| Shine A Light Counseling Center, Inc | |
|
700 Frederick St Ste 103 Santa Cruz CA 95062 | |
| (831) 222-0111 | |
| (831) 417-0443 |
| Full Name | Shine A Light Counseling Center, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 700 Frederick St Ste 103, Santa Cruz, California |
| Authorized Official Name and Position | Timothy Vincent Hartnett (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8312220111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine A Light Counseling Center, Inc 700 Frederick St Ste 103 Santa Cruz CA 95062-2239 Ph: (831) 222-0111 | Shine A Light Counseling Center, Inc 700 Frederick St Ste 103 Santa Cruz CA 95062 Ph: (831) 222-0111 |
| NPI Number | 1689058349 |
|---|---|
| Provider Enumeration Date | 07/13/2015 |
| Last Update Date | 11/05/2019 |
| Medicare PECOS PAC ID | 6406281211 |
|---|---|
| Medicare Enrollment ID | O20200123002227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689058349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (California) | Primary |
| Provider Name | Emily Solick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639335755 PECOS PAC ID: 7416247945 Enrollment ID: I20160613000071 |
| Provider Name | Timothy Vincent Hartnett |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1124006408 PECOS PAC ID: 0941635759 Enrollment ID: I20240104003378 |
| Provider Name | Marceya B Kagan |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1235797176 PECOS PAC ID: 8820435472 Enrollment ID: I20240319002434 |
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