MEDICARE: TRANSITIONS LIFE SKILLS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1073005377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONS LIFE SKILLS, LLC

Provider Business Mailing Address
First Line	:	2017 BANCROFT ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-2009
Country	:	US
Telephone Number	:	337-292-0032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 BANCROFT ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-2009
Country	:	US
Telephone Number	:	337-292-0032
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KIMBERLY WILLIAMS LEWIS
Credential	:	LMSW
Telephone Number	:	337-292-0032

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	06/01/2018

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