MEDICARE: TRANSFORMATIONAL CONCEPTS PLLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LPC-16122	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1205382694	OTHER	AZ	NA
2	1669549929	OTHER	AZ	NA

General Provider Information

NPI Number	:	1932656360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIONAL CONCEPTS PLLC

Provider Business Mailing Address
First Line	:	3861 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1301
Country	:	US
Telephone Number	:	520-209-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3861 N 1ST AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-1301
Country	:	US
Telephone Number	:	520-209-1755
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OUT PATIENT SERVICES
Name	:	ZACHARY MARULLI SABER
Credential	:	LMT
Telephone Number	:	520-209-1755

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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Directions to “TRANSFORMATIONAL CONCEPTS PLLC ” Practice Location

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