MEDICARE: COMPLETE TRANSFORMATIONS, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1770976516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE TRANSFORMATIONS, LLC

Provider Business Mailing Address
First Line	:	2439 MANHATTAN BLVD
Second Line	:	SUITE 405
City	:	HARVEY
State	:	LA
Zip	:	70058-5328
Country	:	US
Telephone Number	:	504-366-1399
Fax Number	:	504-366-4094

Provider Business Practice Location Address
First Line	:	2439 MANHATTAN BLVD
Second Line	:	SUITE 405
City	:	HARVEY
State	:	LA
Zip	:	70058-5328
Country	:	US
Telephone Number	:	504-366-1399
Fax Number	:	504-366-4094

Authorized Official
Title or Position	:	CEO
Name	:	MR. TERRENCE TROY FENDERSON
Credential	:	LCSW
Telephone Number	:	504-366-1399

Provider Enumeration Date	:	03/17/2015
Last Update Date	:	03/17/2015

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