MEDICARE: TRANSITIONS, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3936	MN
2	103T00000X	Psychologist	2240	MN

General Provider Information

NPI Number	:	1356676472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONS, LTD

Provider Business Mailing Address
First Line	:	23 4TH ST SE
Second Line	:	217
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-1090
Country	:	US
Telephone Number	:	612-379-8050
Fax Number	:	612-379-8069

Provider Business Practice Location Address
First Line	:	23 4TH ST SE
Second Line	:	217
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-1090
Country	:	US
Telephone Number	:	612-379-8050
Fax Number	:	612-379-8069

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	MS. DOLORES JANE MATTHEWS
Credential	:	M.A.
Telephone Number	:	612-379-8050

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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