Healthcare Provider Details

I. General information

NPI: 1932761285
Provider Name (Legal Business Name): TRANSFORMATIVE THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2019
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2334 W LAWRENCE AVE STE 204
CHICAGO IL
60625-1045
US

IV. Provider business mailing address

3631 N SAINT LOUIS AVE
CHICAGO IL
60618-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-263-7550
  • Fax:
Mailing address:
  • Phone: 773-273-7550
  • Fax: 844-868-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JANE NIERMANN
Title or Position: OWNER
Credential: LCSW
Phone: 773-263-7550