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General NPI Number Information
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NPI Number | 1366080004
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND THERAPY SERVICES PLLC
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 8308 OFFICE PARK DR STE 2
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City | GRAND BLANC
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State | MI
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Zip | 48439-2075
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Country | US
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Telephone | 810-226-9202
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Fax |
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Provider Business Mailing Address
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Address Line | 8387 E COLDWATER RD
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City | DAVISON
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State | MI
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Zip | 48423-8966
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Country | US
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Telephone | 810-226-9202
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | AUTUMN WARD
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Credential | LMSW
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Telephone | 810-226-9202
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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 |
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License Number State |
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