Provider Demographics
NPI:1407598345
Name:INTEGRATIVE TRANSFORMATIONS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE TRANSFORMATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-769-5830
Mailing Address - Street 1:6 GLOVER RD
Mailing Address - Street 2:
Mailing Address - City:MILLBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01527-1404
Mailing Address - Country:US
Mailing Address - Phone:508-216-0237
Mailing Address - Fax:508-519-0417
Practice Address - Street 1:6 GLOVER RD
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-1404
Practice Address - Country:US
Practice Address - Phone:508-216-0237
Practice Address - Fax:508-519-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health