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General NPI Number Information
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NPI Number | 1467007179
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH TRANSFORMATIONS LLC
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 08/09/2020
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Provider Practice Location Address
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Address Line | 324 N 2ND ST
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3343
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Country | US
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Telephone | 386-530-5158
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Fax | 386-693-4081
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Provider Business Mailing Address
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Address Line | 324 N 2ND ST
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City | FLAGLER BEACH
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State | FL
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Zip | 32136-3343
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Country | US
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Telephone | 386-530-5158
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Fax | 386-693-4081
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KORIN A MENARD
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Credential | LMHC, RBT, MA
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Telephone | 386-530-5158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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