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General NPI Number Information
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NPI Number | 1023513371
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 03/28/2018
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Last Update Date | 09/12/2020
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Provider Practice Location Address
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Address Line | 5301 BUCKEYSTOWN PIKE STE 440
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City | FREDERICK
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State | MD
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Zip | 21704-8370
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Country | US
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Telephone | 240-651-3890
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Fax | 240-815-6015
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Provider Business Mailing Address
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Address Line | 5301 BUCKEYSTOWN PIKE STE 440
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City | FREDERICK
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State | MD
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Zip | 21704-8370
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Country | US
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Telephone | 240-651-3890
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Fax | 240-815-6015
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHOUH-RONG VIVIAN TSAI
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Credential | PSY.D.
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Telephone | 240-651-3890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 05117
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License Number State | MD
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