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General NPI Number Information
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NPI Number | 1598692089
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Entity Type | Organization
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Legal Business Name | MINDSHIFT & WELLNESS PLLC
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 28777 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 313-645-5188
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Fax |
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Provider Business Mailing Address
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Address Line | 11000 W MCNICHOLS RD STE 323
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City | DETROIT
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State | MI
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Zip | 48221-2393
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Country | US
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Telephone | 313-645-5188
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Fax |
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Authorized Official
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Title or Position | CO- OWNER
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Name | KATRINA IVORY
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Credential | PMHNP- BC
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Telephone | 313-649-5188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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