Provider Demographics
NPI:1376953760
Name:SKILLFULLY TRANSFORMING LLC
Entity Type:Organization
Organization Name:SKILLFULLY TRANSFORMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAMLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP
Authorized Official - Phone:612-432-8046
Mailing Address - Street 1:3420 18TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2327
Mailing Address - Country:US
Mailing Address - Phone:612-432-8046
Mailing Address - Fax:
Practice Address - Street 1:4161 MINNEHAHA AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-4339
Practice Address - Country:US
Practice Address - Phone:612-432-8046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty