MEDICARE: TRANSFORMING LIVES CONSULTANT FIRM 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1861156507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMING LIVES CONSULTANT FIRM LLC

Provider Business Mailing Address
First Line	:	201 CENTURY VILLAGE BLVD STE 234
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-2008
Country	:	US
Telephone Number	:	318-914-2632
Fax Number	:	318-855-3998

Provider Business Practice Location Address
First Line	:	201 CENTURY VILLAGE BLVD STE 234
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-2008
Country	:	US
Telephone Number	:	318-914-2632
Fax Number	:	318-855-3998

Authorized Official
Title or Position	:	CAC/MHP
Name	:	TAMERA TAYLOR
Credential	:	CAC
Telephone Number	:	318-914-2632

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	09/05/2023

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