Organization
TRANSFORM THERAPY CO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA LATRAILLE LPC-A (THERAPIST)
(763) 957-0648
Entity
Organization
Contact information
Practice address
4825 DAVIS LN APT 1331, AUSTIN, TX 78749-4576
(763) 957-0648
Mailing address
4825 DAVIS LN APT 1331, AUSTIN, TX 78749-4576
(763) 957-0648
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/14/2024
Last updated
09/14/2024
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