MEDICARE: SHIFT HAPPENS THERAPY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1720858988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFT HAPPENS THERAPY SERVICES

Provider Business Mailing Address
First Line	:	5801 LEESBURG PIKE # 1054
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2301
Country	:	US
Telephone Number	:	571-322-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 LEESBURG PIKE # 1054
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2301
Country	:	US
Telephone Number	:	571-322-6987
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE DONOVAN
Credential	:	LCSW
Telephone Number	:	703-577-7946

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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