Provider Demographics
NPI:1649891953
Name:TRANSFORMATIVE CARE
Entity type:Organization
Organization Name:TRANSFORMATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BUSTAMANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-618-0852
Mailing Address - Street 1:1187 E CHARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2603
Mailing Address - Country:US
Mailing Address - Phone:928-607-4677
Mailing Address - Fax:
Practice Address - Street 1:4055 S 700 E STE 102F
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2174
Practice Address - Country:US
Practice Address - Phone:801-618-0852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty