Healthcare Provider Details

I. General information

NPI: 1982454377
Provider Name (Legal Business Name): INNERCORE TRANSFORMATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S FRONTIER PKWY
SNOWFLAKE AZ
85937-6449
US

IV. Provider business mailing address

116 S FRONTIER PKWY
SNOWFLAKE AZ
85937-6449
US

V. Phone/Fax

Practice location:
  • Phone: 907-775-8742
  • Fax: 888-265-5270
Mailing address:
  • Phone: 190-777-5874
  • Fax: 888-265-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LINDA A RASMUSSEN
Title or Position: OWNER
Credential: LCSW
Phone: 907-775-8742