MEDICARE: TRANQUILITY COUNSELING LLC

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	MH11858	FL

General Provider Information

NPI Number	:	1821445792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUILITY COUNSELING LLC

Provider Business Mailing Address
First Line	:	801 W BAY DR STE 425
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33770-3223
Country	:	US
Telephone Number	:	727-365-9365
Fax Number	:	844-773-9456

Provider Business Practice Location Address
First Line	:	801 W BAY DR STE 425
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33770-3223
Country	:	US
Telephone Number	:	727-365-9365
Fax Number	:	844-773-9456

Authorized Official
Title or Position	:	OWNER AND PROVIDER
Name	:	JENNIFER BOTELHO
Credential	:	LMHC
Telephone Number	:	727-365-9365

Provider Enumeration Date	:	05/19/2016
Last Update Date	:	11/28/2016

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