Healthcare Provider Details

I. General information

NPI: 1841984010
Provider Name (Legal Business Name): SHAPE MENTAL HEALTH & WELLNESS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GLOBAL VIEW DR
WARRENDALE PA
15086-7612
US

IV. Provider business mailing address

100 GLOBAL VIEW DR
WARRENDALE PA
15086-7612
US

V. Phone/Fax

Practice location:
  • Phone: 412-518-2158
  • Fax:
Mailing address:
  • Phone: 412-518-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRADFORD JAMES HANES
Title or Position: OWNER / THERAPIST
Credential: MS, MBA, LPC, NCC
Phone: 412-518-2158