MEDICARE: TIME MENTAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1326846684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIME MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	1631 NE BROADWAY ST # 2110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1425
Country	:	US
Telephone Number	:	503-208-5032
Fax Number	:

Provider Business Practice Location Address
First Line	:	17908 QUITMAN MOUNTAIN WAY
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-7232
Country	:	US
Telephone Number	:	503-208-5032
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & CEO
Name	:	DR. KYLER TODD SHUMWAY
Credential	:	PSYD
Telephone Number	:	503-403-9397

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/04/2025

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