MEDICARE: TRANSITIONS BEHAVIORAL HEALTH, 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	101Y00000X	Counselor	3590-125	WI

General Provider Information

NPI Number	:	1831419324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONS BEHAVIORAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 445
Second Line	:
City	:	PORTAGE
State	:	WI
Zip	:	53901-0445
Country	:	US
Telephone Number	:	608-617-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 DEWITT ST
Second Line	:
City	:	PORTAGE
State	:	WI
Zip	:	53901-2155
Country	:	US
Telephone Number	:	608-617-5400
Fax Number	:

Authorized Official
Title or Position	:	CLINIC ADMINISTRATOR
Name	:	JESSICA LYNN BECKETT
Credential	:	LPC
Telephone Number	:	608-617-5400

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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