MEDICARE: AMAZING TRANSITIONS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1992520761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAZING TRANSITIONS

Provider Business Mailing Address
First Line	:	230 HOLLYWOOD DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-1547
Country	:	US
Telephone Number	:	936-363-6730
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 HOLLYWOOD DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77303-1547
Country	:	US
Telephone Number	:	936-363-6730
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN/QMHP/LPA
Name	:	LAKEYAH BLAYLOCK
Credential	:
Telephone Number	:	936-363-6730

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	11/18/2024

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Directions to “AMAZING TRANSITIONS ” Practice Location

Language	Start Address	Practice Location

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