=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831772391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANSFORMATIONS THERAPEUTIC SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2021
-----------------------------------------------------
Last Update Date | 05/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 ROBERT J CONLAN BLVD NE
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-210-3681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1501 ROBERT J CONLAN BLVD NE
-----------------------------------------------------
City | PALM BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32905-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-210-3681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST COUNSELOR
-----------------------------------------------------
Name | ALISA MCGEE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 321-210-3681
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------