Provider Demographics
NPI:1245467950
Name:STATE OF TRANQUILITY LLC
Entity type:Organization
Organization Name:STATE OF TRANQUILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SARTORI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:405-625-9886
Mailing Address - Street 1:PO BOX 5848
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5848
Mailing Address - Country:US
Mailing Address - Phone:405-625-9886
Mailing Address - Fax:405-310-4670
Practice Address - Street 1:860 COPPERFIELD DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4147
Practice Address - Country:US
Practice Address - Phone:405-625-9886
Practice Address - Fax:405-310-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty