NPIMap

Organization Active NPI

Shine Integrative Therapy, LLC

  • Marriage & Family Therapist
  • Newton, KS
National Provider Identifier
1578080412
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
2885 Issued in KS
Legal business name
SHINE INTEGRATIVE THERAPY, LLC
Practice address
1103 N Main St
Newton, KS 67114-1837
Phone
(316) 803-1011
Fax
(316) 803-1754
NPI assigned
Aug 22, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy Smith, LCMFTNPI 1033636972
Title
Owner
Phone
(316) 803-1011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 2885 KS Primary

Addresses

Primary practice location

1103 N Main St
Newton, KS 67114-1837

Mailing address

1103 N Main St
Newton, KS 67114-1837
Phone (316) 993-6449

Other identifiers 1

IdentifierTypeStateIssuer
201168070MedicaidKS

National Provider Directory

National Provider Directory

Locations

900 N Poplar St
Ste 103
Newton, KS 67114
Phone (316) 765-1295

1103 N Main St
Newton, KS 67114
Phone (316) 803-1011

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1578080412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 N MAIN ST",
            "city": "NEWTON",
            "state": "KS",
            "postal_code": "671141837",
            "telephone_number": "316-993-6449",
            "fax_number": "316-803-1754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 N MAIN ST",
            "city": "NEWTON",
            "state": "KS",
            "postal_code": "671141837",
            "telephone_number": "316-803-1011",
            "fax_number": "316-803-1754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE INTEGRATIVE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-22",
        "last_updated": "2022-07-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-803-1011",
        "authorized_official_credential": "LCMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "KS",
            "license": "2885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201168070",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newton, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.