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General NPI Number Information
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NPI Number | 1629407762
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIONAL WELLNESS LLC
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 652 N PIERCE ST
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City | LARAMIE
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State | WY
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Zip | 82070-6032
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Country | US
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Telephone | 307-399-0003
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Fax | 307-742-6572
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Provider Business Mailing Address
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Address Line | 652 N PIERCE ST
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City | LARAMIE
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State | WY
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Zip | 82070-6032
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Country | US
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Telephone | 307-399-0003
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Fax | 307-742-6572
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | LISA TUTHILL
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Credential | LPC
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Telephone | 307-399-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1309
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License Number State | WY
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