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General NPI Number Information
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NPI Number | 1558801746
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Entity Type | Organization
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Legal Business Name | A TRANSFORMING LIFE WELLNESS CTR LLC
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 781 BETA DR SUITE K1
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City | MAYFIELD VILLAGE
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State | OH
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Zip | 44143-2356
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Country | US
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Telephone | 440-565-7833
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Fax | 440-684-9030
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Provider Business Mailing Address
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Address Line | 7085 W 130TH ST #201A
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-7851
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Country | US
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Telephone | 440-565-7833
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Fax | 440-684-9030
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN RICHARDSON
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Credential | LPCC
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Telephone | 216-702-8526
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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 | E0500069
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License Number State | OH
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