Healthcare Provider Details

I. General information

NPI: 1154539716
Provider Name (Legal Business Name): THERAPEUTIC ALLIANCE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FOREST AVE STE 209
PARAMUS NJ
07652-5238
US

IV. Provider business mailing address

10 FOREST AVE STE 209
PARAMUS NJ
07652-5238
US

V. Phone/Fax

Practice location:
  • Phone: 551-265-4448
  • Fax: 888-777-9691
Mailing address:
  • Phone: 551-265-4448
  • Fax: 888-777-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00306000
License Number StateNJ

VIII. Authorized Official

Name: TRACY ALLISON HANS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 888-777-9691