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General NPI Number Information
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NPI Number | 1972977072
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Entity Type | Organization
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Legal Business Name | TRANQUILITY THERAPY PLLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 14 7TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4753
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Country | US
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Telephone | 320-259-4000
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Fax | 320-259-4074
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Provider Business Mailing Address
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Address Line | 14 7TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4753
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Country | US
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Telephone | 320-259-4000
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Fax | 320-259-4074
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Authorized Official
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Title or Position | OWNER/CLINICAL THERAPIST
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Name | DEBORAH VOGT
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Credential | L.M.F.T.
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Telephone | 320-259-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1405
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License Number State | MN
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