Provider Demographics
NPI:1952180515
Name:TRANSCENDENCE PSYCHOLOGICAL SERVICES AND WELLNESS LLC
Entity type:Organization
Organization Name:TRANSCENDENCE PSYCHOLOGICAL SERVICES AND WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LADC
Authorized Official - Phone:612-314-3076
Mailing Address - Street 1:1377 COUNTY ROAD E W
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3654
Mailing Address - Country:US
Mailing Address - Phone:651-503-9787
Mailing Address - Fax:
Practice Address - Street 1:2489 RICE ST STE 180
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3795
Practice Address - Country:US
Practice Address - Phone:612-314-3076
Practice Address - Fax:651-377-4363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEE THAO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-25
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1972012391Medicaid