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General NPI Number Information
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NPI Number | 1669062154
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Entity Type | Organization
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Legal Business Name | TRANQUIL PATH THERAPY LLC
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD STE 555
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1265
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Country | US
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Telephone | 314-502-9243
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Fax |
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Provider Business Mailing Address
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Address Line | 986 PIEDRAS PKWY
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City | FENTON
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State | MO
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Zip | 63026-3757
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Country | US
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Telephone | 314-502-9243
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MANDY BOWLIN
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Credential | LCSW
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Telephone | 314-502-9243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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