Provider Demographics
NPI:1942774963
Name:TRAUMA CHANGED PSYCHOTHERAPY SERVICES, INC.
Entity type:Organization
Organization Name:TRAUMA CHANGED PSYCHOTHERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-308-7171
Mailing Address - Street 1:5444 CRENSHAW BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2408
Mailing Address - Country:US
Mailing Address - Phone:323-505-9500
Mailing Address - Fax:310-933-1414
Practice Address - Street 1:5444 CRENSHAW BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2408
Practice Address - Country:US
Practice Address - Phone:323-505-9500
Practice Address - Fax:310-933-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty