Healthcare Provider Details

I. General information

NPI: 1699616342
Provider Name (Legal Business Name): TRANSFORMATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 CITY PARK AVE # B5
COLUMBUS OH
43215-5780
US

IV. Provider business mailing address

490 CITY PARK AVE # B5
COLUMBUS OH
43215-5780
US

V. Phone/Fax

Practice location:
  • Phone: 614-653-6961
  • Fax:
Mailing address:
  • Phone: 614-653-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: KYNETTA MCFARLANE
Title or Position: OWNER
Credential:
Phone: 614-653-6961