=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063060770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANSCEND THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2019
-----------------------------------------------------
Last Update Date | 09/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4452 PARK BLVD STE 204
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92116-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-823-1382
-----------------------------------------------------
Fax | 888-618-3258
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4452 PARK BLVD STE 204
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92116-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-823-1382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MARIA CECILIA AHRENS
-----------------------------------------------------
Credential | LCSW, CEAP
-----------------------------------------------------
Telephone | 619-823-1382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------