Healthcare Provider Details

I. General information

NPI: 1801736822
Provider Name (Legal Business Name): PEACEFUL MINDS WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E 5900 S
SALT LAKE CITY UT
84107-7330
US

IV. Provider business mailing address

202 E 5900 S
SALT LAKE CITY UT
84107-7330
US

V. Phone/Fax

Practice location:
  • Phone: 702-527-0660
  • Fax:
Mailing address:
  • Phone: 702-527-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: IMAN THOMAS
Title or Position: OWNER
Credential:
Phone: 702-527-0660