Healthcare Provider Details

I. General information

NPI: 1457677601
Provider Name (Legal Business Name): PEACES 'N PUZSOULS: JOURNIES THRU HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W STE S326
SAINT PAUL MN
55104-2801
US

IV. Provider business mailing address

1821 UNIVERSITY AVE W STE S326
SAINT PAUL MN
55104-2801
US

V. Phone/Fax

Practice location:
  • Phone: 651-797-4094
  • Fax: 651-797-4094
Mailing address:
  • Phone: 651-797-4094
  • Fax: 651-797-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number14893
License Number StateMN

VIII. Authorized Official

Name: SHEILA SWEENEY
Title or Position: OWNER/THERAPIST
Credential: LICSW
Phone: 651-797-4094