Provider Demographics
NPI:1760814909
Name:TRANSFORMATIONAL GROWTH LLC
Entity Type:Organization
Organization Name:TRANSFORMATIONAL GROWTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:KEOUGH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, CAP, NBCCH
Authorized Official - Phone:813-846-2690
Mailing Address - Street 1:3750 GUNN HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-8911
Mailing Address - Country:US
Mailing Address - Phone:813-846-2690
Mailing Address - Fax:
Practice Address - Street 1:3750 GUNN HWY STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-8911
Practice Address - Country:US
Practice Address - Phone:813-846-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPY8200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health