Provider Demographics
NPI:1508677295
Name:TRANSFORMATIVE JUSTICE COMMUNITY
Entity type:Organization
Organization Name:TRANSFORMATIVE JUSTICE COMMUNITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:RICHARD TYLER
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-I, CRM-II
Authorized Official - Phone:808-773-2991
Mailing Address - Street 1:5932 NE GLISAN ST STE F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3754
Mailing Address - Country:US
Mailing Address - Phone:808-773-2991
Mailing Address - Fax:
Practice Address - Street 1:5932 NE GLISAN ST STE F
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3754
Practice Address - Country:US
Practice Address - Phone:808-773-2991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSFORMATIVE JUSTICE COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-14
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty