| Tranquility Legacy | |
|
9821 Perfect Dr Port Saint Lucie FL 34986-3032 | |
| (239) 641-4346 | |
| Not Available |
| Full Name | Tranquility Legacy |
|---|---|
| Speciality | Counselor |
| Location | 9821 Perfect Dr, Port Saint Lucie, Florida |
| Authorized Official Name and Position | Carla D Glasgow (CARLA GLASGOW) |
| Authorized Official Contact | 2396414346 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tranquility Legacy Po Box 880591 Port Saint Lucie FL 34988-0591 Ph: (239) 641-4346 | Tranquility Legacy 9821 Perfect Dr Port Saint Lucie FL 34986-3032 Ph: (239) 641-4346 |
| NPI Number | 1295586790 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 04/01/2024 |
| Certification Date | 04/01/2024 |
| Medicare PECOS PAC ID | 1658712120 |
|---|---|
| Medicare Enrollment ID | O20240515000974 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295586790 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Carla Diandre Glasgow |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730783010 PECOS PAC ID: 4486091063 Enrollment ID: I20240319000091 |
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