MEDICARE: TRANSITIONS PSYCHOLOGY GROUP 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		CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821164187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONS PSYCHOLOGY GROUP LLC

Provider Business Mailing Address
First Line	:	7251 W 20TH ST
Second Line	:	BLDG M-2
City	:	GREELEY
State	:	CO
Zip	:	80634-4626
Country	:	US
Telephone Number	:	970-336-1123
Fax Number	:	970-351-0182

Provider Business Practice Location Address
First Line	:	7251 W 20TH ST
Second Line	:	BLDG M-2
City	:	GREELEY
State	:	CO
Zip	:	80634-4626
Country	:	US
Telephone Number	:	970-336-1123
Fax Number	:	970-351-0182

Authorized Official
Title or Position	:	CO-DIRECTOR
Name	:	MR. GREGORY S CREED
Credential	:	PHD, LPC
Telephone Number	:	970-336-1123

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	09/01/2016

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