Healthcare Provider Details

I. General information

NPI: 1871346866
Provider Name (Legal Business Name): THERAPEUTIC MIND SHIFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 COUNTY ROAD 608
ANGLETON TX
77515-2063
US

IV. Provider business mailing address

222 COUNTY ROAD 608
ANGLETON TX
77515-2063
US

V. Phone/Fax

Practice location:
  • Phone: 979-248-4542
  • Fax:
Mailing address:
  • Phone: 979-248-4542
  • 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 Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEQUITA LORENE FROST
Title or Position: OWNER
Credential:
Phone: 979-248-4542