Healthcare Provider Details

I. General information

NPI: 1659803773
Provider Name (Legal Business Name): PEACE OF MIND MENTAL HEALTH SERVICES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7356 JACARANDA LANE
MIAMI LAKES FL
33014
US

IV. Provider business mailing address

7356 JACARANDA LANE
MIAMI LAKES FL
33014
US

V. Phone/Fax

Practice location:
  • Phone: 786-252-9131
  • Fax:
Mailing address:
  • Phone: 786-252-9131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH10200
License Number StateFL

VIII. Authorized Official

Name: MARIA ESTHER MEDINA
Title or Position: CEO
Credential: LMHC
Phone: 786-252-9131