Organization
TRANQUIL SPACE BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAYRENE VICTORIANO (OWNER)
(725) 400-1888
Entity
Organization
Contact information
Practice address
800 N RAINBOW BLVD STE 130, LAS VEGAS, NV 89107-1190
(725) 400-1888
Mailing address
800 N RAINBOW BLVD STE 130, LAS VEGAS, NV 89107-1190
(702) 374-6792
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/05/2021
Last updated
04/26/2023
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