Healthcare Provider Details

I. General information

NPI: 1750217444
Provider Name (Legal Business Name): PEAKMIND MENTAL HEALTH & PERFORMANCE WELLNESS, PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 MARSH ST
SAN LUIS OBISPO CA
93401-3316
US

IV. Provider business mailing address

1368 MARSH ST
SAN LUIS OBISPO CA
93401-3316
US

V. Phone/Fax

Practice location:
  • Phone: 805-619-9915
  • Fax:
Mailing address:
  • Phone: 805-619-9915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSE DELONG
Title or Position: OWNER
Credential: PMHNP
Phone: 805-619-9915