Provider Demographics
NPI:1174921977
Name:NEW TRANSITION THERAPY, LLC
Entity type:Organization
Organization Name:NEW TRANSITION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRISTAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BYRNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-919-6185
Mailing Address - Street 1:400 39TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-3936
Mailing Address - Country:US
Mailing Address - Phone:813-919-6185
Mailing Address - Fax:
Practice Address - Street 1:400 39TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3936
Practice Address - Country:US
Practice Address - Phone:813-919-6185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12786101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty