Provider Demographics
NPI:1194480228
Name:SHIFT HAPPENS TRANSFORMATIVE COUNSELING LLC
Entity type:Organization
Organization Name:SHIFT HAPPENS TRANSFORMATIVE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORDELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:480-751-9288
Mailing Address - Street 1:3289 E ARIS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4235
Mailing Address - Country:US
Mailing Address - Phone:480-751-9288
Mailing Address - Fax:480-522-3825
Practice Address - Street 1:1930 S ALMA SCHOOL RD STE B212
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2104
Practice Address - Country:US
Practice Address - Phone:480-751-9288
Practice Address - Fax:480-522-3825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty