Provider Demographics
NPI:1487368130
Name:TRANSCEND OUTDOOR THERAPY LLC
Entity type:Organization
Organization Name:TRANSCEND OUTDOOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LLPC
Authorized Official - Phone:231-429-2979
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-0338
Mailing Address - Country:US
Mailing Address - Phone:231-429-2979
Mailing Address - Fax:
Practice Address - Street 1:21299 LOIS LN
Practice Address - Street 2:
Practice Address - City:HOWARD CITY
Practice Address - State:MI
Practice Address - Zip Code:49329-8737
Practice Address - Country:US
Practice Address - Phone:231-429-2979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty