Provider Demographics
NPI:1376262303
Name:TRANQUILITY MENTAL AND BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:TRANQUILITY MENTAL AND BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-660-0572
Mailing Address - Street 1:14192 CARLISLE LN
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4542
Mailing Address - Country:US
Mailing Address - Phone:601-660-0572
Mailing Address - Fax:
Practice Address - Street 1:14192 CARLISLE LN
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4542
Practice Address - Country:US
Practice Address - Phone:601-660-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1354625OtherSECRETARY OF STATE