MEDICARE: PEACEFUL HEALING THERAPEUTIC SERVICES LLC

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	:	1730066416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL HEALING THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	12530 FAIRWOOD PKWY STE 102
Second Line	:	#1147
City	:	BOWIE
State	:	MD
Zip	:	20720-6357
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12530 FAIRWOOD PKWY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6356
Country	:	US
Telephone Number	:	202-656-3734
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRONTE' VAUGHN
Credential	:	LCPC
Telephone Number	:	202-656-3734

Provider Enumeration Date	:	08/16/2025
Last Update Date	:	12/21/2025

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