Provider Demographics
NPI:1154539716
Name:THERAPEUTIC ALLIANCE GROUP, INC.
Entity type:Organization
Organization Name:THERAPEUTIC ALLIANCE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:888-777-9691
Mailing Address - Street 1:10 FOREST AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5238
Mailing Address - Country:US
Mailing Address - Phone:551-265-4448
Mailing Address - Fax:888-777-9691
Practice Address - Street 1:10 FOREST AVE STE 209
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5238
Practice Address - Country:US
Practice Address - Phone:551-265-4448
Practice Address - Fax:888-777-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00306000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062308Medicaid