MEDICARE: TRANQUIL SOUL THERAPY AN INDIVIDUAL MARRIAGE AND FAMILY COUNSELING CORPORATION

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	:	1801607858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUIL SOUL THERAPY AN INDIVIDUAL MARRIAGE AND FAMILY COUNSELING CORPORATION

Provider Business Mailing Address
First Line	:	1415 MCKINLEY AVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-1911
Country	:	US
Telephone Number	:	760-877-9188
Fax Number	:	951-858-9215

Provider Business Practice Location Address
First Line	:	2150 N CENTRE CITY PKWY STE M
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-1347
Country	:	US
Telephone Number	:	760-642-1202
Fax Number	:	951-858-9215

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE BABETTE KOUT
Credential	:	MS, LMFT
Telephone Number	:	760-642-1202

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	01/17/2025

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