Provider Demographics
NPI:1902914278
Name:PSYCHOLOGICAL TRANSITIONS, INC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL TRANSITIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD MSCP
Authorized Official - Phone:216-215-8000
Mailing Address - Street 1:3850 E HARBOR LIGHT LANDING DR
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3877
Mailing Address - Country:US
Mailing Address - Phone:419-734-3333
Mailing Address - Fax:419-734-3335
Practice Address - Street 1:3850 E HARBOR LIGHT LANDING DR
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-3877
Practice Address - Country:US
Practice Address - Phone:419-734-3333
Practice Address - Fax:877-734-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182403Medicaid
OH222324000OtherMAGELLAN
OH9276641Medicare ID - Type Unspecified