Provider Demographics
NPI:1871192724
Name:TRANSFORMING TRAUMA COUNSELING
Entity Type:Organization
Organization Name:TRANSFORMING TRAUMA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-394-0165
Mailing Address - Street 1:4624 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2702
Mailing Address - Country:US
Mailing Address - Phone:951-394-0165
Mailing Address - Fax:951-534-0642
Practice Address - Street 1:4624 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2702
Practice Address - Country:US
Practice Address - Phone:951-394-0165
Practice Address - Fax:951-534-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5078742Medicaid