MEDICARE: PEACE OF MIND COUNSELING AND CONSULTING

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1710517594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACE OF MIND COUNSELING AND CONSULTING

Provider Business Mailing Address
First Line	:	PO BOX 769699
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-9358
Country	:	US
Telephone Number	:	210-995-0144
Fax Number	:	210-346-1988

Provider Business Practice Location Address
First Line	:	10434 BRANCH POST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2436
Country	:	US
Telephone Number	:	210-995-0144
Fax Number	:	210-346-1988

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ELROY JAMES BROWN II
Credential	:	LCSW
Telephone Number	:	210-995-0144

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	01/22/2020

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