1184781320 NPI number — TRANQUILITY COUNSELING & WELLNESS CENTER

Table of content: (NPI 1184781320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184781320 NPI number — TRANQUILITY COUNSELING & WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRANQUILITY COUNSELING & WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184781320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 30-2
Provider Business Mailing Address City Name:
TOMS RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08753-7436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-580-4964
Provider Business Mailing Address Fax Number:
732-901-9124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 30-2
Provider Business Practice Location Address City Name:
TOMS RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08753-7436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-580-4964
Provider Business Practice Location Address Fax Number:
732-901-9124
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHARPE
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
732-580-4964

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  37PC003096000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: 44SC05298900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2201451 . This is a "CIGNA PROVIDER ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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