| Shine Integrated Therapy | |
|
3035 W 25th Ave Denver CO 80211-4635 | |
| (303) 455-2409 | |
| Not Available |
| Full Name | Shine Integrated Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 3035 W 25th Ave, Denver, Colorado |
| Authorized Official Name and Position | Elizabeth Clark (OWNER) |
| Authorized Official Contact | 30345524019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Integrated Therapy 2820 Wolff St Denver CO 80212-1521 Ph: (303) 455-2409 | Shine Integrated Therapy 3035 W 25th Ave Denver CO 80211-4635 Ph: (303) 455-2409 |
| NPI Number | 1639553944 |
|---|---|
| Provider Enumeration Date | 07/16/2015 |
| Last Update Date | 03/07/2016 |
| Medicare PECOS PAC ID | 8527364652 |
|---|---|
| Medicare Enrollment ID | O20160315002356 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639553944 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 992361 (Colorado) | Primary |
| Provider Name | Elizabeth A Clark |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083098842 PECOS PAC ID: 2668778796 Enrollment ID: I20160315002568 |
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