=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528658200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SHANI PROJECT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2021
-----------------------------------------------------
Last Update Date | 01/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5871 CEDAR LAKE RD S STE 216
-----------------------------------------------------
City | ST LOUIS PARK
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55416-3805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-938-9414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3317 S HIGLEY RD STE 114-858
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85297-5436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-938-9414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHANI D TRAN
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 480-938-9414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------