MEDICARE: TRAUMA CHANGED PSYCHOTHERAPY SERVICES, INC.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1942774963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA CHANGED PSYCHOTHERAPY SERVICES, INC.

Provider Business Mailing Address
First Line	:	5444 CRENSHAW BLVD STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2408
Country	:	US
Telephone Number	:	323-505-9500
Fax Number	:	310-933-1414

Provider Business Practice Location Address
First Line	:	5444 CRENSHAW BLVD STE 201
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-2408
Country	:	US
Telephone Number	:	323-505-9500
Fax Number	:	310-933-1414

Authorized Official
Title or Position	:	CO-FOUNDER/CFO
Name	:	JOHN T CASEY
Credential	:	LCSW
Telephone Number	:	562-308-7171

Provider Enumeration Date	:	01/12/2019
Last Update Date	:	01/12/2019

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