Healthcare Provider Details

I. General information

NPI: 1023747615
Provider Name (Legal Business Name): TRANSFORMATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6818 GROVER ST STE 301
OMAHA NE
68106-3632
US

IV. Provider business mailing address

3240 S 45TH ST
OMAHA NE
68106-4028
US

V. Phone/Fax

Practice location:
  • Phone: 402-650-9601
  • Fax:
Mailing address:
  • Phone: 402-650-9601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN GRANGER
Title or Position: OWNER
Credential: LIMHP
Phone: 402-650-9601