Provider Demographics
NPI:1306584354
Name:TRANQUIL LIFE MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:TRANQUIL LIFE MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OUTPATIENT PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:612-386-3588
Mailing Address - Street 1:14870 GRANADA AVE # 1033
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5514
Mailing Address - Country:US
Mailing Address - Phone:612-386-3588
Mailing Address - Fax:
Practice Address - Street 1:658 E 143RD ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4609
Practice Address - Country:US
Practice Address - Phone:612-386-3588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty