Healthcare Provider Details

I. General information

NPI: 1649160862
Provider Name (Legal Business Name): PEACE OF MIND TELEHEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE R
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 224-900-6463
  • Fax:
Mailing address:
  • Phone: 224-900-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: VLADIMIR VICTOR EUGENE
Title or Position: MANAGING MEMBER
Credential: PA-C
Phone: 224-900-6463