MEDICARE: TRANSFORMING LIVES 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QR0400X	Rehabilitation Clinic/Center
5	251S00000X	Community/Behavioral Health Agency	15042	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	600938112	OTHER	MD	MAGELLAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	R505-0162	OTHER	MD	CHOICE
4	2311946	OTHER	MD	COMPYSCH
5	284769	OTHER	MD	USFHP

General Provider Information

NPI Number	:	1992230338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMING LIVES COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1900 E NORTHERN PKWY STE T5
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21239-2120
Country	:	US
Telephone Number	:	410-645-1000
Fax Number	:	667-205-1382

Provider Business Practice Location Address
First Line	:	1900 E NORTHERN PKWY STE T5
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21239-2120
Country	:	US
Telephone Number	:	410-645-1000
Fax Number	:	672-051-3826

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. MELISSA ANNETTE POWELL
Credential	:	LCSW-C
Telephone Number	:	410-645-1000

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	07/15/2020

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