Healthcare Provider Details

I. General information

NPI: 1619668050
Provider Name (Legal Business Name): PEACE WITHIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 E WILMETTE RD STE B
PALATINE IL
60074-6495
US

IV. Provider business mailing address

375 COVINGTON DR
BARRINGTON IL
60010-6614
US

V. Phone/Fax

Practice location:
  • Phone: 312-317-2866
  • Fax:
Mailing address:
  • Phone: 312-317-2866
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MEGAN LYN RETTBERG SMITH
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 312-317-2866