Healthcare Provider Details

I. General information

NPI: 1609112002
Provider Name (Legal Business Name): PEACE OF MIND COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12773 FOREST HILL BLVD STE 209
WELLINGTON FL
33414-4762
US

IV. Provider business mailing address

12773 FOREST HILL BLVD STE 209
WELLINGTON FL
33414-4762
US

V. Phone/Fax

Practice location:
  • Phone: 561-328-9870
  • Fax:
Mailing address:
  • Phone: 561-328-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1550AD931401
License Number StateFL

VIII. Authorized Official

Name: JOSE FLORES
Title or Position: ACCOUNT SPECIALIST
Credential:
Phone: 754-201-2265