Provider Demographics
NPI:1942571732
Name:TRANSFORMING LIFE COUNSELING CENTER MID0DEL
Entity Type:Organization
Organization Name:TRANSFORMING LIFE COUNSELING CENTER MID0DEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:405-410-4770
Mailing Address - Street 1:3001 TINKER DIAGONAL ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-1017
Mailing Address - Country:US
Mailing Address - Phone:405-411-0477
Mailing Address - Fax:
Practice Address - Street 1:3001 TINKER DIAGONAL ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-1017
Practice Address - Country:US
Practice Address - Phone:405-411-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty