Healthcare Provider Details

I. General information

NPI: 1457596322
Provider Name (Legal Business Name): PEACE OF MIND PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 SW FEDERAL HWY SUITE 200B
STUART FL
34994-2952
US

IV. Provider business mailing address

819 SW FEDERAL HWY SUITE 200B
STUART FL
34994-2952
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-9566
  • Fax: 772-220-8381
Mailing address:
  • Phone: 772-219-9566
  • Fax: 772-220-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3693
License Number StateFL

VIII. Authorized Official

Name: DONNA ECHLIN DONAN
Title or Position: PRESIDENT
Credential: LMHC
Phone: 772-219-9566