| Transformation Mental Health Therapy, Pllc | |
|
2005 N Ironwood Pkwy Ste 120 Coeur D Alene ID 83814-2647 | |
| (208) 704-0342 | |
| Not Available |
| Full Name | Transformation Mental Health Therapy, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 2005 N Ironwood Pkwy Ste 120, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Kimberly Lynn Shelden (OWNER/THERAPIST) |
| Authorized Official Contact | 2087040342 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformation Mental Health Therapy, Pllc 2005 N Ironwood Pkwy Ste 120 Coeur D Alene ID 83814-2647 Ph: (208) 704-0342 | Transformation Mental Health Therapy, Pllc 2005 N Ironwood Pkwy Ste 120 Coeur D Alene ID 83814-2647 Ph: (208) 704-0342 |
| NPI Number | 1033996236 |
|---|---|
| Provider Enumeration Date | 09/11/2023 |
| Last Update Date | 03/03/2026 |
| Certification Date | 03/03/2026 |
| Medicare PECOS PAC ID | 6800241373 |
|---|---|
| Medicare Enrollment ID | O20231018003593 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033996236 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Kimberly Lynn Shelden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083143382 PECOS PAC ID: 9638503733 Enrollment ID: I20191226000465 |
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