Provider Demographics
NPI:1003522723
Name:TRANQUILITY WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:TRANQUILITY WELLNESS GROUP, LLC
Other - Org Name:ELLIE MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-704-7575
Mailing Address - Street 1:5668 FISHHAWK CROSSING BLVD # 142
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5900
Mailing Address - Country:US
Mailing Address - Phone:904-704-7575
Mailing Address - Fax:
Practice Address - Street 1:109 N OAKWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4629
Practice Address - Country:US
Practice Address - Phone:904-704-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty