# SHINE PEDIATRIC PSYCHOLOGY SERVICES PLLC

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

## Provider details

- **NPI number:** 1982321964
- **Authorized official:** DR. MICHELLE BOUCHER-SNODGRASS PH.D. (LICENSED PSYCHOLOGIST/OWNER)
- **Authorized official phone:** (601) 282-5250

## Contact information

- **Practice address:** 2449 N PARK DR STE C, MERIDIAN, MS 39305-2669
- **Practice address phone:** (601) 282-5250
- **Practice address fax:** (601) 286-5305
- **Mailing address:** 2449 N PARK DR STE C, MERIDIAN, MS 39305-2669
- **Mailing address phone:** (601) 282-5250
- **Mailing address fax:** (601) 286-5305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/20/2022
- **Last updated:** 10/20/2022