Provider Demographics
NPI:1548952849
Name:INNER ALCHEMY TRAUMA HEALING & TRANSFORMATION
Entity type:Organization
Organization Name:INNER ALCHEMY TRAUMA HEALING & TRANSFORMATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MFT
Authorized Official - Phone:541-887-9304
Mailing Address - Street 1:534 TORREY ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1364
Mailing Address - Country:US
Mailing Address - Phone:541-331-4766
Mailing Address - Fax:
Practice Address - Street 1:534 TORREY ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1364
Practice Address - Country:US
Practice Address - Phone:541-331-4766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty