Provider Demographics
NPI:1255954780
Name:THE TRANSFORMATION SPECIALISTS LLC
Entity type:Organization
Organization Name:THE TRANSFORMATION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-381-1170
Mailing Address - Street 1:813 ASH ST
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2213
Mailing Address - Country:US
Mailing Address - Phone:708-381-1170
Mailing Address - Fax:
Practice Address - Street 1:813 ASH ST
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2213
Practice Address - Country:US
Practice Address - Phone:708-381-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180010704Medicaid