Healthcare Provider Details

I. General information

NPI: 1366915944
Provider Name (Legal Business Name): PEACE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10461 6 MILE CYPRESS PKWY STE 504
FORT MYERS FL
33966-6513
US

IV. Provider business mailing address

10461 6 MILE CYPRESS PKWY STE 504
FORT MYERS FL
33966-6513
US

V. Phone/Fax

Practice location:
  • Phone: 941-467-2980
  • Fax:
Mailing address:
  • Phone: 941-467-2980
  • 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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY DOUGLAS LAPHAM
Title or Position: DIRECTOR
Credential: LMHC
Phone: 941-467-2980