Provider Demographics
NPI:1700150554
Name:TRANSFORMING LIVES, LLC
Entity Type:Organization
Organization Name:TRANSFORMING LIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER, PRESIDENT/FAMILY SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-508-3112
Mailing Address - Street 1:8500 COUNTY ROAD 813
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-3866
Mailing Address - Country:US
Mailing Address - Phone:256-509-6308
Mailing Address - Fax:
Practice Address - Street 1:1220 SAINT JOSEPH ST NW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2310
Practice Address - Country:US
Practice Address - Phone:256-508-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2378101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty