Provider Demographics
NPI:1134534209
Name:TRANQUILITY LIFE COUNSELING, INC.
Entity type:Organization
Organization Name:TRANQUILITY LIFE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:TAMAKLOE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:321-356-6265
Mailing Address - Street 1:815 N MAGNOLIA AVE
Mailing Address - Street 2:C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3810
Mailing Address - Country:US
Mailing Address - Phone:321-356-6265
Mailing Address - Fax:
Practice Address - Street 1:815 N MAGNOLIA AVE.
Practice Address - Street 2:C
Practice Address - City:ORLANDO
Practice Address - State:FLORIDA
Practice Address - Zip Code:32803
Practice Address - Country:UM
Practice Address - Phone:321-356-6265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW84671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768138100Medicaid