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NPI Code Detail

MEDICARE: MENTAL SHIFTS LLC

MEDICARE: MENTAL SHIFTS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1215590617
Entity Type Code : Organization
Provider Name (Legal Business Name) : MENTAL SHIFTS LLC
Provider Business Mailing Address
First Line : 1980 FESTIVAL PLAZA DR STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-2930
Country : US
Telephone Number : 702-856-4711
Fax Number :
Provider Business Practice Location Address
First Line : 1980 FESTIVAL PLAZA DR STE 300
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-2930
Country : US
Telephone Number : 702-856-4711
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JARED M. GRANT
Credential : PSYD
Telephone Number : 602-820-2662
Provider Enumeration Date : 04/21/2019
Last Update Date : 04/21/2019

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Directions to “MENTAL SHIFTS LLC ” Practice Location

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