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Organization

SHINE FORTH LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JUDIANN BRYANT LPC (LPC/PROVIDER)
(719) 248-1789
Entity
Organization

Contact information

Practice address
6710 WILLSHIRE BLVD, CHEYENNE, WY 82009-2757
(719) 248-1789
(307) 514-1080
Mailing address
6710 WILLSHIRE BLVD, CHEYENNE, WY 82009-2757
(719) 248-1789

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
153780600
WY
Enumeration date
10/22/2020
Last updated
10/22/2020
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