Provider Demographics
NPI:1184431009
Name:TRANQUIL PEAKS WELLNESS AND CONSULTATION
Entity type:Organization
Organization Name:TRANQUIL PEAKS WELLNESS AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-919-2289
Mailing Address - Street 1:1925 GRAND AVE STE 129
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2776
Mailing Address - Country:US
Mailing Address - Phone:502-919-2289
Mailing Address - Fax:
Practice Address - Street 1:3840 MULLAN ROAD
Practice Address - Street 2:APT. 210
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808
Practice Address - Country:US
Practice Address - Phone:502-919-2289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty