MEDICARE: TRAUMA RECOVERY AND COUNSELING SERVICES LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1477189777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA RECOVERY AND COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	17723 FRANKLIN AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-3518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3886 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-4119
Country	:	US
Telephone Number	:	216-404-6748
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID ANDERSON
Credential	:	LPCC
Telephone Number	:	216-404-6748

Provider Enumeration Date	:	03/18/2020
Last Update Date	:	03/18/2020

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