Healthcare Provider Details

I. General information

NPI: 1467371245
Provider Name (Legal Business Name): TRANQUIL LEAF MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 WALTERS ST
BETHLEHEM PA
18017-6021
US

IV. Provider business mailing address

PO BOX 222
BETHLEHEM PA
18016-0222
US

V. Phone/Fax

Practice location:
  • Phone: 610-871-8192
  • Fax: 610-460-0354
Mailing address:
  • Phone: 610-871-8192
  • Fax: 610-460-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ZACHARY MAICHUK
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 610-871-8192