Provider Demographics
NPI:1497136154
Name:SHIFT COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:SHIFT COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WIMSATT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW, CAC III
Authorized Official - Phone:970-462-7717
Mailing Address - Street 1:518 28 RD
Mailing Address - Street 2:BLDG A STE 201
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6556
Mailing Address - Country:US
Mailing Address - Phone:970-462-7717
Mailing Address - Fax:
Practice Address - Street 1:518 28 RD
Practice Address - Street 2:BLDG A STE 201
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6556
Practice Address - Country:US
Practice Address - Phone:970-462-7717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO753251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health