NPIMap

Organization Active NPI

Transformation Behavioral Health Associates LLC

  • Clinical Psychologist
  • Woodstock, IL
National Provider Identifier
1710225644
Registry record updated Aug 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071006683 Issued in IL
Legal business name
TRANSFORMATION BEHAVIORAL HEALTH ASSOCIATES LLC
Practice address
1090 McConnell Rd
Woodstock, IL 60098-7310
Phone
(815) 245-6669
Fax
(815) 334-1640
NPI assigned
Jan 28, 2013
Last updated
Aug 31, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kelly Vinehout, PSYDNPI 1134263999
Title
Clinical Director
Phone
(815) 245-6669

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071006683 IL Primary

Addresses

Primary practice location

1090 McConnell Rd
Woodstock, IL 60098-7310

Mailing address

PO Box 1861
Woodstock, IL 60098-1861
Phone (815) 245-6669

Other identifiers 3

IdentifierTypeStateIssuer
11894012OtherILCAQH
600016119OtherILMAGELLAN
35641736OtherILBCBS

Other names 1

  • Creative Alternatives for Psychological Growth LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Creative Alternatives for Psychological Growth LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440979200000",
    "number": "1710225644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1861",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600981861",
            "telephone_number": "815-245-6669",
            "fax_number": "815-334-1640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 MCCONNELL RD",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987310",
            "telephone_number": "815-245-6669",
            "fax_number": "815-334-1640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSFORMATION BEHAVIORAL HEALTH ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-28",
        "last_updated": "2015-08-31",
        "status": "A",
        "authorized_official_last_name": "VINEHOUT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "815-245-6669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11894012",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "600016119",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "35641736",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creative Alternatives for Psychological Growth LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Woodstock, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.