MEDICARE: SHADES OF HEALING THERAPY, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1841924065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADES OF HEALING THERAPY, PLLC

Provider Business Mailing Address
First Line	:	5014 FJORD CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-1056
Country	:	US
Telephone Number	:	760-362-2847
Fax Number	:

Provider Business Practice Location Address
First Line	:	5014 FJORD CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-1056
Country	:	US
Telephone Number	:	832-263-1050
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	SHEENA DRUMMOND
Credential	:
Telephone Number	:	832-263-1050

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	08/09/2022

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