Provider Demographics
NPI:1376754267
Name:TRANQUIL MIND & WELLNESS, INC
Entity Type:Organization
Organization Name:TRANQUIL MIND & WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-947-1683
Mailing Address - Street 1:6 ALBERTA LN
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1864
Mailing Address - Country:US
Mailing Address - Phone:508-273-3726
Mailing Address - Fax:
Practice Address - Street 1:6 ALBERTA LN
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1864
Practice Address - Country:US
Practice Address - Phone:508-273-3726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA1028860101YM0800X
MA175441163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP30156Medicaid
MA349493OtherMAGELLAN BEHAVIORAL
MAP10263OtherBCBS OF MASS
MAP30156Medicaid