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General NPI Number Information
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NPI Number | 1104296193
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE EFFECTS LLC
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Dates
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Enumeration Date | 10/02/2015
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 410C SE 3RD ST STE 108
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2849
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Country | US
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Telephone | 660-530-3086
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Fax | 660-530-3086
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Provider Business Mailing Address
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Address Line | 410C SE 3RD ST STE 108
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City | LEES SUMMIT
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State | MO
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Zip | 64063-2849
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Country | US
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Telephone | 660-530-3086
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Fax | 660-530-3086
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | KYLE ALTENDERFER
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Credential |
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Telephone | 660-530-3086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2014008259
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License Number State | MO
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