Provider Demographics
NPI:1215590617
Name:MENTAL SHIFTS LLC
Entity Type:Organization
Organization Name:MENTAL SHIFTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:602-820-2662
Mailing Address - Street 1:1980 FESTIVAL PLAZA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2930
Mailing Address - Country:US
Mailing Address - Phone:702-856-4711
Mailing Address - Fax:
Practice Address - Street 1:1980 FESTIVAL PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2930
Practice Address - Country:US
Practice Address - Phone:702-856-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-21
Last Update Date:2019-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty