Provider Demographics
NPI:1851837801
Name:RAELARA TILDEN, LMFT INC
Entity Type:Organization
Organization Name:RAELARA TILDEN, LMFT INC
Other - Org Name:TRANQUIL LIFE FAMILY INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CLINICAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAELARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-517-1519
Mailing Address - Street 1:1355 SILVER SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2159
Mailing Address - Country:US
Mailing Address - Phone:702-517-1519
Mailing Address - Fax:702-829-2876
Practice Address - Street 1:2725 S JONES BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5667
Practice Address - Country:US
Practice Address - Phone:702-517-1519
Practice Address - Fax:702-829-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0591251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health