Provider Demographics
NPI:1003634155
Name:TRANSFORMATIONAL CONNECTIONS COUNSELING & CONSULTING
Entity type:Organization
Organization Name:TRANSFORMATIONAL CONNECTIONS COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCPC, CRC
Authorized Official - Phone:734-212-2522
Mailing Address - Street 1:3953 W DAKIN ST UNIT 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3101
Mailing Address - Country:US
Mailing Address - Phone:248-736-0173
Mailing Address - Fax:
Practice Address - Street 1:3420 W FOSTER AVE STE A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6971
Practice Address - Country:US
Practice Address - Phone:734-212-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty