Provider Demographics
NPI:1316547904
Name:PAWSITIVELY TRANSFORMATIONAL HEALTH AND WELLNESS INC
Entity Type:Organization
Organization Name:PAWSITIVELY TRANSFORMATIONAL HEALTH AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:REDEKOPP
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-208-6364
Mailing Address - Street 1:1111 10TH ST # 400
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 DOOLEY ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8203
Practice Address - Country:US
Practice Address - Phone:575-404-1577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-01
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)