Provider Demographics
NPI:1437749702
Name:SHIFT LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:SHIFT LIMITED LIABILITY COMPANY
Other - Org Name:SHIFT MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, LPCC
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC, NCC
Authorized Official - Phone:612-562-6605
Mailing Address - Street 1:12800 WHITEWATER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9347
Mailing Address - Country:US
Mailing Address - Phone:612-562-6605
Mailing Address - Fax:
Practice Address - Street 1:12800 WHITEWATER DR STE 100
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9347
Practice Address - Country:US
Practice Address - Phone:612-562-6605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty