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General NPI Number Information
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NPI Number | 1689429615
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Entity Type | Organization
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Legal Business Name | TLC BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 3600 LIME ST BLDG 2
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City | RIVERSIDE
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State | CA
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Zip | 92501-2971
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Country | US
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Telephone | 562-895-5264
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 LIME ST BLDG 2
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City | RIVERSIDE
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State | CA
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Zip | 92501-2971
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATRICE CALLOWAY
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Credential |
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Telephone | 562-895-5264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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