Provider Demographics
NPI:1720532807
Name:TRANSMOGRIFY COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:TRANSMOGRIFY COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:708-846-0864
Mailing Address - Street 1:23819 W MILL ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-3457
Mailing Address - Country:US
Mailing Address - Phone:708-846-0864
Mailing Address - Fax:815-327-0214
Practice Address - Street 1:23819 W MILL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-3457
Practice Address - Country:US
Practice Address - Phone:708-846-0864
Practice Address - Fax:815-327-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007521261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health