Provider Demographics
NPI:1922035211
Name:TRANQUIL MOMENTS, PLLC
Entity Type:Organization
Organization Name:TRANQUIL MOMENTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PMHNP, BC
Authorized Official - Phone:606-669-1507
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-0661
Mailing Address - Country:US
Mailing Address - Phone:606-365-7007
Mailing Address - Fax:606-365-7001
Practice Address - Street 1:704 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-1405
Practice Address - Country:US
Practice Address - Phone:606-365-7007
Practice Address - Fax:606-365-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2829P261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1179045OtherCHA
KY78028297Medicaid
KYUPIN S84421Medicare UPIN
KY78028297Medicaid