MEDICARE: PARADIGM SHIFT THERAPIES, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1831683192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADIGM SHIFT THERAPIES, LLC

Provider Business Mailing Address
First Line	:	130 E CORONADO RD UNIT 17
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1597
Country	:	US
Telephone Number	:	602-595-4755
Fax Number	:	480-247-4377

Provider Business Practice Location Address
First Line	:	2024 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2515
Country	:	US
Telephone Number	:	602-595-4755
Fax Number	:	480-247-4377

Authorized Official
Title or Position	:	OWNER
Name	:	TODD A SCHERZER
Credential	:	LPC
Telephone Number	:	602-595-4755

Provider Enumeration Date	:	06/20/2018
Last Update Date	:	06/20/2018

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