MEDICARE: PEACEFUL MIND THERAPY, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		NV

General Provider Information

NPI Number	:	1841792751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEACEFUL MIND THERAPY, LLC

Provider Business Mailing Address
First Line	:	4169 CRAIGEND LOOP
Second Line	:
City	:	GULF SHORES
State	:	AL
Zip	:	36542-5822
Country	:	US
Telephone Number	:	702-325-4670
Fax Number	:

Provider Business Practice Location Address
First Line	:	2509 TANBARK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3876
Country	:	US
Telephone Number	:	702-254-6703
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	ODELIA DUHEL
Credential	:
Telephone Number	:	702-325-4670

Provider Enumeration Date	:	03/06/2018
Last Update Date	:	12/02/2023

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