Healthcare Provider Details

I. General information

NPI: 1861379794
Provider Name (Legal Business Name): IMPACT MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15170 N HAYDEN RD STE 1
SCOTTSDALE AZ
85260-2571
US

IV. Provider business mailing address

4400 N SCOTTSDALE RD # 9-918
SCOTTSDALE AZ
85251-3331
US

V. Phone/Fax

Practice location:
  • Phone: 561-699-0706
  • Fax:
Mailing address:
  • Phone: 480-332-8832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SCHAPIRO
Title or Position: OWNER
Credential:
Phone: 561-699-0706