MEDICARE: TRANSFORMED MINDS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6513	LA

General Provider Information

NPI Number	:	1407369341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMED MINDS LLC

Provider Business Mailing Address
First Line	:	3811 NAPOLEON AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70125-4443
Country	:	US
Telephone Number	:	504-249-3628
Fax Number	:

Provider Business Practice Location Address
First Line	:	4422 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-4830
Country	:	US
Telephone Number	:	504-249-3628
Fax Number	:	504-891-1172

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA TORREGANO WATSON
Credential	:	LCSW
Telephone Number	:	504-908-9688

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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Directions to “TRANSFORMED MINDS LLC ” Practice Location

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