MEDICARE: PEACEFUL MIND II 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1760133664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL MIND II LLC

Provider Business Mailing Address
First Line	:	14621 EXMOOR CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73142-7814
Country	:	US
Telephone Number	:	405-313-2153
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 N MAY AVE STE 102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-3422
Country	:	US
Telephone Number	:	405-418-7574
Fax Number	:

Authorized Official
Title or Position	:	LPC
Name	:	JORDAN ELISABETH FELDMANN
Credential	:
Telephone Number	:	405-418-7574

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	04/28/2022

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