Provider Demographics
NPI:1578324455
Name:TRANQUIL WATERS COUNSELING LLC
Entity Type:Organization
Organization Name:TRANQUIL WATERS COUNSELING LLC
Other - Org Name:TRANQUIL WATERS COUNSELING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:218-407-4247
Mailing Address - Street 1:522 BELTRAMI AVE STE. 9
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601
Mailing Address - Country:US
Mailing Address - Phone:218-407-4247
Mailing Address - Fax:
Practice Address - Street 1:522 BELTRAMI AVE. NW SUITE 9
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-407-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty