Active NPI
Shine Fitness LLC
Doing business as Shine Integrated Therapy
- Clinical Social Worker
- Denver, CO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 992361
- Legal business name
- SHINE FITNESS LLC
- Doing business as
- Shine Integrated Therapy
- Practice address
- 3035 W 25TH Ave
Denver, CO 80211-4635 - Phone
- (303) 455-2409
- NPI assigned
- Jul 16, 2015
- Last updated
- Mar 7, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Elizabeth Clark, LCSW
- Title
- Owner
- Phone
- 30345524019
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 992361 | CO | Primary |
Addresses
Primary practice location
3035 W 25TH Ave
Denver, CO 80211-4635
Mailing address
2820 Wolff St
Denver, CO 80212-1521
Phone (303) 455-2409
Other names 1
- Shine Integrated Therapy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
Enrollment records 1
National Provider Directory
National Provider Directory- Tax ID family
- Shine Fitness
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Clinical Social Worker
- Denver, CO
- NPI 1083098842
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437004800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1457308800000",
"number": "1639553944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2820 WOLFF ST",
"city": "DENVER",
"state": "CO",
"postal_code": "802121521",
"telephone_number": "303-455-2409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3035 W 25TH AVE",
"city": "DENVER",
"state": "CO",
"postal_code": "802114635",
"telephone_number": "303-455-2409"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHINE FITNESS LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-07-16",
"last_updated": "2016-03-07",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "ELIZABETH",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "30345524019",
"authorized_official_credential": "LCSW"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "992361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Shine Integrated Therapy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.