Healthcare Provider Details

I. General information

NPI: 1093645996
Provider Name (Legal Business Name): TRANSFORMATIVE CONNECTIONS THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENMOOR AVE SE STE 301
GRAND RAPIDS MI
49546-2395
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 301
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 616-315-0354
  • Fax:
Mailing address:
  • Phone: 616-315-0354
  • Fax:

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: TIARA MONIQUE-LEANDRA PARKS
Title or Position: MENTAL HEALTH THERAPIST
Credential: LMSW
Phone: 616-726-0062