Healthcare Provider Details

I. General information

NPI: 1740020932
Provider Name (Legal Business Name): PSYCHSHIFT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 TOWNSHIP ROAD 1329
IRONTON OH
45638-8378
US

IV. Provider business mailing address

454 TOWNSHIP ROAD 1329
IRONTON OH
45638-8378
US

V. Phone/Fax

Practice location:
  • Phone: 304-654-7557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELANIE DANIELSON
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 304-654-7557