# SHINE A LIGHT FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629765599
- **Authorized official:** JIMMY DURBIN LCSW (CLINICAL SUPERVISOR)
- **Authorized official phone:** (702) 883-4464

## Contact information

- **Practice address:** 2330 HIGHLAND DR STE 205, LAS VEGAS, NV 89102-4810
- **Practice address phone:** (725) 222-4654
- **Mailing address:** 2330 HIGHLAND DR STE 205, LAS VEGAS, NV 89102-4810
- **Mailing address phone:** (702) 863-4704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 04/20/2023
- **Last updated:** 04/20/2023