Provider Demographics
NPI:1942563622
Name:BE TRANSFORMED, INC
Entity type:Organization
Organization Name:BE TRANSFORMED, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRITTON-GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-730-7773
Mailing Address - Street 1:6111 HARRISON STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2972
Mailing Address - Country:US
Mailing Address - Phone:219-730-7773
Mailing Address - Fax:219-455-6231
Practice Address - Street 1:6111 HARRISON STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2972
Practice Address - Country:US
Practice Address - Phone:219-730-7773
Practice Address - Fax:219-455-6231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040724A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN215920OtherMEDICARE PTIN
IN200034070CMedicaid
IN215920Medicare PIN