Provider Demographics
NPI:1114683596
Name:TRANQUIL PINES COUNSELING LLC
Entity Type:Organization
Organization Name:TRANQUIL PINES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCADC, ACS
Authorized Official - Phone:908-294-5898
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-6117
Mailing Address - Country:US
Mailing Address - Phone:908-294-5898
Mailing Address - Fax:
Practice Address - Street 1:411 KAILA CT
Practice Address - Street 2:
Practice Address - City:SHAMONG
Practice Address - State:NJ
Practice Address - Zip Code:08088-9688
Practice Address - Country:US
Practice Address - Phone:609-401-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty