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General NPI Number Information
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NPI Number | 1457853723
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Entity Type | Organization
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Legal Business Name | PEACEFUL MIND COUNSELING, LLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 2739 NAVARRE AVE STE 302
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City | OREGON
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State | OH
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Zip | 43616-3277
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Country | US
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Telephone | 419-559-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 2739 NAVARRE AVE STE 302
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City | OREGON
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State | OH
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Zip | 43616-3277
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY J TIMMONS
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Credential | PCC, LICDC
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Telephone | 419-559-5100
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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 |
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License Number State |
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