Provider Demographics
NPI:1568177152
Name:TRANSFORMATION THERAPY, PLLC
Entity Type:Organization
Organization Name:TRANSFORMATION THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-227-3373
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:KIPLING
Mailing Address - State:NC
Mailing Address - Zip Code:27543-0264
Mailing Address - Country:US
Mailing Address - Phone:984-227-3733
Mailing Address - Fax:
Practice Address - Street 1:917 SEQUOIA RIDGE DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2580
Practice Address - Country:US
Practice Address - Phone:984-227-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710287750OtherNPI