Provider Demographics
NPI:1952819401
Name:BECOMING TRANSFORMED LLC
Entity Type:Organization
Organization Name:BECOMING TRANSFORMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:602-618-8024
Mailing Address - Street 1:PO BOX 7641
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0110
Mailing Address - Country:US
Mailing Address - Phone:602-618-8024
Mailing Address - Fax:623-933-8625
Practice Address - Street 1:20470 N LAKE PLEASANT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-9705
Practice Address - Country:US
Practice Address - Phone:602-618-8024
Practice Address - Fax:623-933-8625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BECOMING TRANSFORMED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12788101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty