Provider Demographics
NPI:1982241436
Name:TRANQUIL SPACES COUNSELING LLC
Entity Type:Organization
Organization Name:TRANQUIL SPACES COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:S
Authorized Official - Last Name:OBER
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LPC
Authorized Official - Phone:402-340-9092
Mailing Address - Street 1:404 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NE
Mailing Address - Zip Code:68769-4008
Mailing Address - Country:US
Mailing Address - Phone:402-340-9092
Mailing Address - Fax:
Practice Address - Street 1:324 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5233
Practice Address - Country:US
Practice Address - Phone:402-340-9092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE50504047703Medicaid