=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629863634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANSMUTE THERAPY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2025
-----------------------------------------------------
Last Update Date | 04/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 N COMMERCIAL ST STE 950C
-----------------------------------------------------
City | BELLINGHAM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98225-4590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-444-7414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1832 EMERALD LAKE WAY
-----------------------------------------------------
City | BELLINGHAM
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98226-7837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST, OWNER
-----------------------------------------------------
Name | NIKKI BRAATEN
-----------------------------------------------------
Credential | MA, LPCC, LMHC
-----------------------------------------------------
Telephone | 320-444-7414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------