| Transformative Health And Wellness | |
|
1300 Nw Harrison Blvd Corvallis OR 97330-6277 | |
| (541) 227-6331 | |
| Not Available |
| Full Name | Transformative Health And Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 Nw Harrison Blvd, Corvallis, Oregon |
| Authorized Official Name and Position | Tracy Lenee Bluhm (OWNER, PROVIDER) |
| Authorized Official Contact | 5412276331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformative Health And Wellness 1300 Nw Harrison Blvd Corvallis OR 97330-6277 Ph: (541) 227-6331 | Transformative Health And Wellness 1300 Nw Harrison Blvd Corvallis OR 97330-6277 Ph: (541) 227-6331 |
| NPI Number | 1972246502 |
|---|---|
| Provider Enumeration Date | 04/20/2022 |
| Last Update Date | 06/18/2024 |
| Certification Date | 06/06/2024 |
| Medicare PECOS PAC ID | 8426592262 |
|---|---|
| Medicare Enrollment ID | O20240703001241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972246502 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Christopher W. Leesman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982981809 PECOS PAC ID: 2961649199 Enrollment ID: I20150526001537 |
| Provider Name | Danielle Gomez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649666777 PECOS PAC ID: 8820387434 Enrollment ID: I20220304002100 |
| Provider Name | Dominic Lathos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043844848 PECOS PAC ID: 4789123472 Enrollment ID: I20240826003357 |
| Provider Name | Taylor Gjesdal |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992461701 PECOS PAC ID: 9739628389 Enrollment ID: I20240827001760 |
| Provider Name | Tracy Lenee Bluhm |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1811306772 PECOS PAC ID: 1153865993 Enrollment ID: I20240827002633 |
| Provider Name | Taryn Stephanie Borsch |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295000867 PECOS PAC ID: 5597204032 Enrollment ID: I20240828000949 |
| Provider Name | Jordyn Hohstadt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962164343 PECOS PAC ID: 0941749410 Enrollment ID: I20240828002228 |
| Provider Name | Jessica White |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285055467 PECOS PAC ID: 1759822935 Enrollment ID: I20240916003585 |
| Provider Name | Kristin Komorowski Wanlin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1861657694 PECOS PAC ID: 6406387729 Enrollment ID: I20240926004564 |
| Provider Name | Nicole Jennings |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1548744253 PECOS PAC ID: 7416488200 Enrollment ID: I20241003003165 |
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