MEDICARE: TRANSMUTE THERAPY, PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1629863634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSMUTE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1832 EMERALD LAKE WAY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-7837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 N COMMERCIAL ST STE 950C
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4590
Country	:	US
Telephone Number	:	320-444-7414
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST, OWNER
Name	:	NIKKI BRAATEN
Credential	:	MA, LPCC, LMHC
Telephone Number	:	320-444-7414

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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