Provider Demographics
NPI:1679334189
Name:HOUSE OF TRANSFORMATION THERAPY SERVICES
Entity Type:Organization
Organization Name:HOUSE OF TRANSFORMATION THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, LICDC
Authorized Official - Phone:330-631-1319
Mailing Address - Street 1:524 CORA PL
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-8902
Mailing Address - Country:US
Mailing Address - Phone:330-631-1319
Mailing Address - Fax:
Practice Address - Street 1:524 CORA PL
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-8902
Practice Address - Country:US
Practice Address - Phone:330-631-1319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty