Healthcare Provider Details

I. General information

NPI: 1720532807
Provider Name (Legal Business Name): TRANSMOGRIFY COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 08/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23819 W MILL ST SUITE 6
PLAINFIELD IL
60544-3457
US

IV. Provider business mailing address

23819 W MILL ST SUITE 6
PLAINFIELD IL
60544-3457
US

V. Phone/Fax

Practice location:
  • Phone: 708-846-0864
  • Fax: 815-327-0214
Mailing address:
  • Phone: 708-846-0864
  • Fax: 815-327-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number180007521
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number180007521
License Number StateIL

VIII. Authorized Official

Name: JAMIE T PAGANO
Title or Position: OWNER/THERAPIST
Credential: MA, LCPC
Phone: 708-846-0864