Provider Demographics
NPI:1790222370
Name:TRANSITIONAL LIFE COUNSELING
Entity Type:Organization
Organization Name:TRANSITIONAL LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:937-769-5019
Mailing Address - Street 1:1525 XENIA AVE
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1123
Mailing Address - Country:US
Mailing Address - Phone:937-769-5019
Mailing Address - Fax:937-769-5019
Practice Address - Street 1:1525 XENIA AVE
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1123
Practice Address - Country:US
Practice Address - Phone:937-769-5019
Practice Address - Fax:937-769-5019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0600045101YP2500X
OH6323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty