MEDICARE: TRANSFORMATIVE COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1528534146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATIVE COUNSELING LLC

Provider Business Mailing Address
First Line	:	512 N 29TH ST STE 202
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1113
Country	:	US
Telephone Number	:	406-697-2952
Fax Number	:

Provider Business Practice Location Address
First Line	:	512 N 29TH ST STE 202
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-1113
Country	:	US
Telephone Number	:	406-697-2952
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	ASHLEE OWENS
Credential	:
Telephone Number	:	406-697-2952

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	10/22/2018

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