Provider Demographics
NPI:1083303010
Name:TRANQUILITY THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:TRANQUILITY THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:253-377-5102
Mailing Address - Street 1:1610 COMMERCIAL AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2258
Mailing Address - Country:US
Mailing Address - Phone:253-377-5102
Mailing Address - Fax:
Practice Address - Street 1:1610 COMMERCIAL AVE STE 207
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2258
Practice Address - Country:US
Practice Address - Phone:253-377-5102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty