Mind Shield and Sword Therapy, LLC
NPI 1467181024ActiveOrganization· Social Worker, Clinical· Lees Summit, MO
Social Worker, Clinical in Lees Summit, Missouri, registered in NPPES in June 2022. The authorized official on file is Dereik Lance Domerese, LCSW, Owner/Member.
Overview
| NPI | 1467181024 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 8, 2022 |
| Last updated in NPPES | Jun 15, 2022 |
| Certified by provider | Jun 15, 2022 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Social Worker, Clinical Primary | 1041C0700X | — | — |
| Social Worker | 104100000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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