Healthcare Provider Details

I. General information

NPI: 1265136352
Provider Name (Legal Business Name): A PEACE OF MINE BY CARLEASE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N STATE HIGHWAY 360
MANSFIELD TX
76063-3509
US

IV. Provider business mailing address

1400 N STATE HIGHWAY 360 APT 1628
MANSFIELD TX
76063-3535
US

V. Phone/Fax

Practice location:
  • Phone: 918-995-9144
  • Fax:
Mailing address:
  • Phone: 918-995-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MS. CARLEASE MONIQUE AUSTIN
Title or Position: OWNER
Credential:
Phone: 918-995-9144