MEDICARE: TRANQUILITY THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1275380974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUILITY THERAPY

Provider Business Mailing Address
First Line	:	409 SPANISH GROVE RD
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924-3906
Country	:	US
Telephone Number	:	434-210-2016
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 SPANISH GROVE RD
Second Line	:
City	:	CHASE CITY
State	:	VA
Zip	:	23924-3906
Country	:	US
Telephone Number	:	434-210-2016
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERDALE SCOTT
Credential	:	LPC
Telephone Number	:	434-210-2016

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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Directions to “TRANQUILITY THERAPY ” Practice Location

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