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General NPI Number Information
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NPI Number | 1154839983
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION THERAPEUTIC COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 316 S HAYES AVE STE D
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City | WAGONER
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State | OK
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Zip | 74467-5531
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Country | US
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Telephone | 918-698-7134
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Fax | 918-485-4317
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Provider Business Mailing Address
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Address Line | 316 S HAYES AVE STE D
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City | WAGONER
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State | OK
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Zip | 74467-5531
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Country | US
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Telephone | 918-698-7134
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Fax | 918-485-4317
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | MELISSA ANN MCDARIS
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Credential | LPC, LADC
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Telephone | 918-698-7134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5299
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License Number State | OK
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