| Shine Integrative Therapy, Llc | |
|
1103 N Main St Newton KS 67114-1837 | |
| (316) 803-1011 | |
| (316) 803-1754 |
| Full Name | Shine Integrative Therapy, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1103 N Main St, Newton, Kansas |
| Authorized Official Name and Position | Tracy Smith (OWNER) |
| Authorized Official Contact | 3168031011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shine Integrative Therapy, Llc 1103 N Main St Newton KS 67114-1837 Ph: (316) 993-6449 | Shine Integrative Therapy, Llc 1103 N Main St Newton KS 67114-1837 Ph: (316) 803-1011 |
| NPI Number | 1578080412 |
|---|---|
| Provider Enumeration Date | 08/22/2017 |
| Last Update Date | 07/21/2022 |
| Certification Date | 06/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578080412 | NPI | - | NPPES |
| 201168070 | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 2885 (Kansas) | Primary |
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