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General NPI Number Information
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NPI Number | 1437749702
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Entity Type | Organization
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Legal Business Name | SHIFT LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 01/21/2021
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 12800 WHITEWATER DR STE 100
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City | MINNETONKA
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State | MN
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Zip | 55343-9347
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Country | US
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Telephone | 612-562-6605
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Fax |
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Provider Business Mailing Address
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Address Line | 12800 WHITEWATER DR STE 100
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City | MINNETONKA
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State | MN
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Zip | 55343-9347
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Country | US
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Telephone | 612-562-6605
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Fax |
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Authorized Official
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Title or Position | OWNER, LPCC
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Name | JANNA MARIE MASON
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Credential | MS, LPCC, NCC
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Telephone | 612-562-6605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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