Provider Demographics
NPI:1356191282
Name:TRANSFORMATIONAL THERAPY PLLC
Entity type:Organization
Organization Name:TRANSFORMATIONAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORAL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BLANKINSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:206-852-7304
Mailing Address - Street 1:4705 226TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4415
Mailing Address - Country:US
Mailing Address - Phone:120-685-2730
Mailing Address - Fax:
Practice Address - Street 1:7500 212TH ST SW STE 106
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7614
Practice Address - Country:US
Practice Address - Phone:206-852-7304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty