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Organization
SHINE FITNESS
Active
Organization
SHINE FITNESS
Active
Other names
Shine Integrated Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH ANNE CLARK LCSW (THERAPIST)
(303) 455-2409
Entity
Organization
Contact information
Practice address
3035 W 25TH AVE, DENVER, CO 80211-4635
(303) 455-2409
Mailing address
2820 WOLFF ST, DENVER, CO 80212-1521
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
992361
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
992361
LICENSE
CO
Enumeration date
05/11/2015
Last updated
05/11/2015
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