Healthcare Provider Details

I. General information

NPI: 1861156507
Provider Name (Legal Business Name): TRANSFORMING LIVES CONSULTANT FIRM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CENTURY VILLAGE BLVD STE 234
MONROE LA
71203-2008
US

IV. Provider business mailing address

201 CENTURY VILLAGE BLVD STE 234
MONROE LA
71203-2008
US

V. Phone/Fax

Practice location:
  • Phone: 318-914-2632
  • Fax: 318-855-3998
Mailing address:
  • Phone: 318-914-2632
  • Fax: 318-855-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMERA TAYLOR
Title or Position: CAC/MHP
Credential: CAC
Phone: 318-914-2632