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General NPI Number Information
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NPI Number | 1265796072
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND THERAPY SERVICES
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 207 BOONE ST SUITE 27
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City | JOHNSON CITY
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State | TN
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Zip | 37604-5603
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Country | US
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Telephone | 423-444-3677
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Fax | 423-244-0602
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Provider Business Mailing Address
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Address Line | 207 BOONE ST SUITE 27
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City | JOHNSON CITY
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State | TN
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Zip | 37604-5603
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Country | US
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Telephone | 423-444-3677
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Fax | 423-244-0602
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. JONATHAN L HARTSELL
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Credential | LCSW
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Telephone | 423-444-3677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4902
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5391
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License Number State | TN
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