Provider Demographics
NPI:1952555864
Name:TRANSFORMATION LIFE CENTER
Entity Type:Organization
Organization Name:TRANSFORMATION LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/SUBSTANCE ABUSE/PAS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:STANCIL DOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:NCC,LIMHP,LADC,LPC,L
Authorized Official - Phone:402-991-2123
Mailing Address - Street 1:2211 PEOPLES RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4670
Mailing Address - Country:US
Mailing Address - Phone:402-991-2123
Mailing Address - Fax:402-991-2172
Practice Address - Street 1:2211 PEOPLES RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4670
Practice Address - Country:US
Practice Address - Phone:402-991-2123
Practice Address - Fax:402-991-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ75258101Y00000X
NE739101YA0400X
NE121101YM0800X
NE3034101YM0800X
NE1569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85673OtherBC/BS/TRICARE
NE10024948100Medicaid
NE273095OtherCOMPSYCH
NE10025624700Medicaid
NE554979000OtherMAGELLAN