Provider Demographics
NPI:1083331664
Name:TRANSCENDING TRAUMA INSTITUTE, PLLC
Entity Type:Organization
Organization Name:TRANSCENDING TRAUMA INSTITUTE, PLLC
Other - Org Name:INTEGRATIVE MIND THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CEO/CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:LAPIERA
Authorized Official - Last Name:SUDDERTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMSW
Authorized Official - Phone:734-353-1463
Mailing Address - Street 1:40315 MICHIGAN AVE # 1234
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2908
Mailing Address - Country:US
Mailing Address - Phone:734-353-1463
Mailing Address - Fax:734-293-0264
Practice Address - Street 1:40315 MICHIGAN AVE # 1234
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2908
Practice Address - Country:US
Practice Address - Phone:734-353-1463
Practice Address - Fax:734-293-0264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871726794Medicaid