Organization
SHINE A LIGHT FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JIMMY DURBIN LCSW (CLINICAL SUPERVISOR)
(702) 883-4464
Entity
Organization
Contact information
Practice address
2330 HIGHLAND DR STE 205, LAS VEGAS, NV 89102-4810
(725) 222-4654
Mailing address
2330 HIGHLAND DR STE 205, LAS VEGAS, NV 89102-4810
(702) 863-4704
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/20/2023
Last updated
04/20/2023
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