Provider Demographics
NPI:1033996236
Name:TRANSFORMATION MENTAL HEALTH THERAPY, PLLC
Entity Type:Organization
Organization Name:TRANSFORMATION MENTAL HEALTH THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-704-0342
Mailing Address - Street 1:843 PLACER CT
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8731
Mailing Address - Country:US
Mailing Address - Phone:208-704-0342
Mailing Address - Fax:888-892-2509
Practice Address - Street 1:843 PLACER CT
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8731
Practice Address - Country:US
Practice Address - Phone:208-704-0342
Practice Address - Fax:888-892-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty