Healthcare Provider Details

I. General information

NPI: 1487368130
Provider Name (Legal Business Name): TRANSCEND OUTDOOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21299 LOIS LN
HOWARD CITY MI
49329-8737
US

IV. Provider business mailing address

PO BOX 338
FREMONT MI
49412-0338
US

V. Phone/Fax

Practice location:
  • Phone: 231-429-2979
  • Fax:
Mailing address:
  • Phone: 231-429-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: JACOB FIELDS
Title or Position: CO-FOUNDER, THERAPIST
Credential: M. ED, LLPC
Phone: 231-429-2979