| Transformation Behavioral Health Pllc | |
|
1090 Mcconnell Rd Woodstock IL 60098-7310 | |
| (815) 575-9675 | |
| Not Available |
| Full Name | Transformation Behavioral Health Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1090 Mcconnell Rd, Woodstock, Illinois |
| Authorized Official Name and Position | Kelly Vinehout (OWNER / CEO) |
| Authorized Official Contact | 8152456669 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformation Behavioral Health Pllc Po Box 1861 Woodstock IL 60098-1861 Ph: () - | Transformation Behavioral Health Pllc 1090 Mcconnell Rd Woodstock IL 60098-7310 Ph: (815) 575-9675 |
| NPI Number | 1659066066 |
|---|---|
| Provider Enumeration Date | 04/11/2023 |
| Last Update Date | 05/02/2024 |
| Certification Date | 05/02/2024 |
| Medicare PECOS PAC ID | 9830631068 |
|---|---|
| Medicare Enrollment ID | O20240604000510 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659066066 | NPI | - | NPPES |
| Provider Name | Kelly N Vinehout |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134263999 PECOS PAC ID: 9830235076 Enrollment ID: I20091001000508 |
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