| Shine Forth Llc | |
|
6710 Willshire Blvd Cheyenne WY 82009-2757 | |
| (719) 248-1789 | |
| (307) 514-1080 |
| Full Name | Shine Forth Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 6710 Willshire Blvd, Cheyenne, Wyoming |
| Authorized Official Name and Position | Judiann Bryant (LPC/PROVIDER) |
| Authorized Official Contact | 7192481789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Forth Llc 6710 Willshire Blvd Cheyenne WY 82009-2757 Ph: (719) 248-1789 | Shine Forth Llc 6710 Willshire Blvd Cheyenne WY 82009-2757 Ph: (719) 248-1789 |
| NPI Number | 1528667201 |
|---|---|
| Provider Enumeration Date | 10/22/2020 |
| Last Update Date | 10/22/2020 |
| Certification Date | 10/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528667201 | NPI | - | NPPES |
| 153780600 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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