Healthcare Provider Details

I. General information

NPI: 1316690373
Provider Name (Legal Business Name): PEACEFUL MIND THERAPEUTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S RIPLEY BLVD
ALPENA MI
49707-3406
US

IV. Provider business mailing address

150 S RIPLEY BLVD
ALPENA MI
49707-3406
US

V. Phone/Fax

Practice location:
  • Phone: 989-465-7400
  • Fax: 989-465-7465
Mailing address:
  • Phone: 989-465-7400
  • Fax: 989-465-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALISHA ALLEN
Title or Position: PRESIDENT
Credential: LLPC
Phone: 989-465-7400