Basic Information
| Provider Information | |||||||||
| NPI: | 1982241436 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRANQUIL SPACES COUNSELING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687694008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023409092 | ||||||||
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| Practice Location | |||||||||
| Address1: | 324 W NORFOLK AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687015233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023409092 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2019 | ||||||||
| LastUpdateDate: | 12/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | OBER | ||||||||
| AuthorizedOfficialFirstName: | TRACI | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4023409092 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LIMHP, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 50504047703 | 05 | NE | MEDICAID |