MEDICARE: A PEACE OF MIND HEALTH & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1619648029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PEACE OF MIND HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	1430 E INDIAN SCHOOL RD STE 230
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4991
Country	:	US
Telephone Number	:	702-807-4726
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 E INDIAN SCHOOL RD STE 230
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4991
Country	:	US
Telephone Number	:	702-807-4726
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. CONSTANCE L KELLY
Credential	:
Telephone Number	:	702-807-4726

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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