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General NPI Number Information
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NPI Number | 1396086880
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Entity Type | Organization
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Legal Business Name | PEACE OF MIND WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 12785 FOREST HILL BLVD SUITE 8C
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City | WELLINGTON
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State | FL
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Zip | 33414-4777
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Country | US
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Telephone | 561-328-9870
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Fax |
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Provider Business Mailing Address
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Address Line | 12785 FOREST HILL BLVD SUITE 8C
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City | WELLINGTON
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State | FL
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Zip | 33414-4777
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Country | US
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Telephone | 561-328-9870
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARITSA YZAGUIRRE
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Credential | LMHC
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Telephone | 561-758-0574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 1550AD444001
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License Number State | FL
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