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General NPI Number Information
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NPI Number | 1811613201
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION MENTAL HEALTH
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 3115 S GRAND BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1046
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Country | US
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Telephone | 314-252-0683
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Fax |
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Provider Business Mailing Address
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Address Line | 3115 S GRAND BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63118-1046
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Country | US
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Telephone | 314-252-0683
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN LIBERATI
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Credential | PHD, LPC
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Telephone | 309-369-4988
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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 |
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License Number State |
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