Provider Demographics
NPI:1710150164
Name:JALY TRANSITIONS INCORPORATED
Entity Type:Organization
Organization Name:JALY TRANSITIONS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-396-2273
Mailing Address - Street 1:1444 E SHELBY DR
Mailing Address - Street 2:SUITE 429
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7260
Mailing Address - Country:US
Mailing Address - Phone:901-396-2273
Mailing Address - Fax:
Practice Address - Street 1:1444 E SHELBY DR
Practice Address - Street 2:SUITE 429
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7260
Practice Address - Country:US
Practice Address - Phone:901-396-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN563101YM0800X, 103T00000X, 106H00000X
MS563101YM0800X, 103T00000X, 106H00000X
TN202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN194822OtherCOMPSYCH
TNBCBSOther4091466