Healthcare Provider Details

I. General information

NPI: 1720538887
Provider Name (Legal Business Name): TRANSITIONING LIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15021 VENTURA BLVD STE 332
SHERMAN OAKS CA
91403-2442
US

IV. Provider business mailing address

15021 VENTURA BLVD STE 332
SHERMAN OAKS CA
91403-2442
US

V. Phone/Fax

Practice location:
  • Phone: 818-570-0337
  • Fax: 877-333-3001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22296
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberPSY22296
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY22296
License Number StateCA

VIII. Authorized Official

Name: SHERRI A TANFERANI
Title or Position: CLINICAL DIRECTOR
Credential: PH.D
Phone: 818-570-0337