Healthcare Provider Details

I. General information

NPI: 1710522842
Provider Name (Legal Business Name): TRANSFORMING MINDS THERAPEUTIC COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 RICHMOND POINTE WAY
RICHLAND MS
39218-6601
US

IV. Provider business mailing address

108 CHARTLEIGH CIR
CANTON MS
39046-1210
US

V. Phone/Fax

Practice location:
  • Phone: 601-720-9945
  • Fax:
Mailing address:
  • Phone: 601-720-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TASHINIKA CROWLEY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 601-720-9945