Provider Demographics
NPI:1629407762
Name:TRANSFORMATIONAL WELLNESS LLC
Entity Type:Organization
Organization Name:TRANSFORMATIONAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTHILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-399-0003
Mailing Address - Street 1:652 N PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-6032
Mailing Address - Country:US
Mailing Address - Phone:307-399-0003
Mailing Address - Fax:307-742-6572
Practice Address - Street 1:652 N PIERCE ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-6032
Practice Address - Country:US
Practice Address - Phone:307-399-0003
Practice Address - Fax:307-742-6572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1309101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty