| Shine Psychotherapy Llc | |
|
5300 Town And Country Blvd Ste 240 Frisco TX 75034-6894 | |
| (657) 377-5522 | |
| Not Available |
| Full Name | Shine Psychotherapy Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5300 Town And Country Blvd Ste 240, Frisco, Texas |
| Authorized Official Name and Position | Eui Kim (CEO) |
| Authorized Official Contact | 4242342924 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Psychotherapy Llc 3813 Cromwell Dr Carrollton TX 75007-2852 Ph: (657) 377-5522 | Shine Psychotherapy Llc 5300 Town And Country Blvd Ste 240 Frisco TX 75034-6894 Ph: (657) 377-5522 |
| NPI Number | 1417661380 |
|---|---|
| Provider Enumeration Date | 01/05/2023 |
| Last Update Date | 01/05/2023 |
| Certification Date | 01/05/2023 |
| Medicare PECOS PAC ID | 8820453152 |
|---|---|
| Medicare Enrollment ID | O20230420001218 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417661380 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Hoanglan Tien Nguyen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386124030 PECOS PAC ID: 9739544065 Enrollment ID: I20230508001435 |
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