Provider Demographics
NPI:1023400553
Name:TRANQUIL TRAILS DOULA
Entity Type:Organization
Organization Name:TRANQUIL TRAILS DOULA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LIANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-906-6913
Mailing Address - Street 1:4694 TOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1128
Mailing Address - Country:US
Mailing Address - Phone:517-906-6913
Mailing Address - Fax:
Practice Address - Street 1:4694 TOLLAND AVE
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1128
Practice Address - Country:US
Practice Address - Phone:517-906-6913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001724225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty