Healthcare Provider Details

I. General information

NPI: 1316456791
Provider Name (Legal Business Name): PEACEFUL MIND THERAPY OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 IMMOKALEE RD
NAPLES FL
34110-4807
US

IV. Provider business mailing address

1185 IMMOKALEE RD STE 220
NAPLES FL
34110-4807
US

V. Phone/Fax

Practice location:
  • Phone: 239-302-7801
  • Fax:
Mailing address:
  • Phone: 239-302-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12440
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMH12440
License Number StateFL

VIII. Authorized Official

Name: MRS. JANE ROSE SIMMONS
Title or Position: OWNER
Credential: LMHC
Phone: 239-302-7801