MEDICARE: TRANSFORMING TRAUMA COUNSELING

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871192724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMING TRAUMA COUNSELING

Provider Business Mailing Address
First Line	:	4624 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2702
Country	:	US
Telephone Number	:	951-394-0165
Fax Number	:	951-534-0642

Provider Business Practice Location Address
First Line	:	4624 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2702
Country	:	US
Telephone Number	:	951-394-0165
Fax Number	:	951-534-0642

Authorized Official
Title or Position	:	OWNER
Name	:	ALICIA MCCLEOD
Credential	:	LMFT
Telephone Number	:	951-394-0165

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	07/14/2021

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Directions to “TRANSFORMING TRAUMA COUNSELING ” Practice Location

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