Healthcare Provider Details

I. General information

NPI: 1801451380
Provider Name (Legal Business Name): TRANSITION ON PURPOSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E MILLS AVE APT 7
BREAUX BRIDGE LA
70517-4415
US

IV. Provider business mailing address

PO BOX 1115
BREAUX BRIDGE LA
70517-1115
US

V. Phone/Fax

Practice location:
  • Phone: 702-245-2876
  • Fax:
Mailing address:
  • Phone: 702-245-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMIKA RENEE SCOTT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MS, ABA, QMHA, QIDP
Phone: 702-245-2876