Healthcare Provider Details

I. General information

NPI: 1881829687
Provider Name (Legal Business Name): TRANSFORMATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E PLUMB LN
RENO NV
89502-3504
US

IV. Provider business mailing address

7606 CORSO ST
RENO NV
89506-5939
US

V. Phone/Fax

Practice location:
  • Phone: 775-232-6610
  • Fax: 775-826-7478
Mailing address:
  • Phone: 775-232-6610
  • Fax: 775-826-7478

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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NORRIS DELANE DUPREE JR.
Title or Position: SOLE PROPRIETOR
Credential: ED.S.
Phone: 775-232-6610