Provider Demographics
NPI:1295586790
Name:TRANQUILITY LEGACY
Entity type:Organization
Organization Name:TRANQUILITY LEGACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARLA GLASGOW
Authorized Official - Prefix:MISS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:239-641-4346
Mailing Address - Street 1:PO BOX 880591
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-0591
Mailing Address - Country:US
Mailing Address - Phone:239-641-4346
Mailing Address - Fax:
Practice Address - Street 1:9821 PERFECT DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3032
Practice Address - Country:US
Practice Address - Phone:239-641-4346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty