=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467051615
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRANQUILITY NOW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2020
-----------------------------------------------------
Last Update Date | 10/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 SW ODESSA TER
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32331-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-556-3698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 SW ODESSA TER
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32331-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-556-3698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. REGINA WATKINS
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 850-556-3698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------