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General NPI Number Information
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NPI Number | 1255720389
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND THERAPY, P.A.
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 2180 IMMOKALEE RD SUITE 216
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City | NAPLES
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State | FL
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Zip | 34110-1421
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Country | US
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Telephone | 239-272-6214
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Fax | 239-596-8901
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Provider Business Mailing Address
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Address Line | 2180 IMMOKALEE RD SUITE 216
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City | NAPLES
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State | FL
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Zip | 34110-1421
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Country | US
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Telephone | 239-272-6214
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Fax | 239-596-8901
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. JANE ROSE SIMMONS
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Credential | LMHC
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Telephone | 239-272-6214
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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 | MH12440
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License Number State | FL
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