Shine Pediatric Psychology Services PLLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

SHINE PEDIATRIC PSYCHOLOGY SERVICES PLLC

Practice address

2449 N Park Dr Ste C
Meridian, MS 39305-2669

Phone

(601) 282-5250

Fax

(601) 286-5305

NPI assigned

Oct 20, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Michelle Boucher-Snodgrass, PH.D.NPI 1386657914

Title

Licensed Psychologist/Owner

Phone

(601) 282-5250

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Michelle Denise Boucher-Snodgrass, PH.D.

  • Psychologist
  • Meridian, MS
  • NPI 1386657914
  NPD Authorized official

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

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1982321964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2449 N PARK DR STE C",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052669",
            "telephone_number": "601-282-5250",
            "fax_number": "601-286-5305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 N PARK DR STE C",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052669",
            "telephone_number": "601-282-5250",
            "fax_number": "601-286-5305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE PEDIATRIC PSYCHOLOGY SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-20",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "BOUCHER-SNODGRASS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "LICENSED PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "601-282-5250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ben J Shirley, CRNA
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• Harvey Miles Shirley, DMD
• Jewel Lynne Shirley, BCBA

• Adolescent and Children Mental Health Clinic/Center in Meridian, MS
• Providers in Meridian, MS by specialty
• Adolescent and Children Mental Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.