Healthcare Provider Details

I. General information

NPI: 1023805892
Provider Name (Legal Business Name): PEACEFUL MIND THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 N RAINBOW PARK DR
WASILLA AK
99623-9241
US

IV. Provider business mailing address

1051 N RAINBOW PARK DR
WASILLA AK
99623-9241
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-3530
  • Fax: 907-376-3520
Mailing address:
  • Phone: 907-376-3530
  • Fax: 907-376-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: VERONICA R MALDONADO
Title or Position: OWNER/CLINICIAN
Credential: MSW, LCSW
Phone: 907-376-3530