Organization
SHINE INTEGRATIVE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY SMITH LCMFT (OWNER)
(316) 803-1011
Entity
Organization
Contact information
Practice address
1103 N MAIN ST, NEWTON, KS 67114-1837
(316) 803-1011
(316) 803-1754
Mailing address
1103 N MAIN ST, NEWTON, KS 67114-1837
(316) 993-6449
(316) 803-1754
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
2885
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201168070
—
KS
Enumeration date
08/22/2017
Last updated
07/21/2022
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