Provider Demographics
NPI:1073192654
Name:TRANSFORM YOUTH AND FAMILY COUNSELING, LLC
Entity type:Organization
Organization Name:TRANSFORM YOUTH AND FAMILY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:BELLENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:541-507-6400
Mailing Address - Street 1:PO BOX 4365
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0168
Mailing Address - Country:US
Mailing Address - Phone:541-507-6400
Mailing Address - Fax:541-500-0112
Practice Address - Street 1:777 NE 7TH ST STE 205
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1632
Practice Address - Country:US
Practice Address - Phone:541-507-6400
Practice Address - Fax:541-479-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty