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General NPI Number Information
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NPI Number | 1154855724
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Entity Type | Organization
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Legal Business Name | THE PEACEFUL MIND FACTORY
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 1165 NW 184TH WAY
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3633
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Country | US
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Telephone | 786-663-3983
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Fax |
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Provider Business Mailing Address
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Address Line | 1165 NW 184TH WAY
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-3633
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Country | US
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Telephone | 786-663-3983
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | ANA MARIA LOPEZ MEDRANO
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Credential | LMHC
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Telephone | 786-663-3983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 14918
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License Number State | FL
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