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General NPI Number Information
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NPI Number | 1669190864
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Entity Type | Organization
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Legal Business Name | INNER PEACE PSYCHIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 211 MOSER AVE UNIT 103
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City | BULLHEAD CITY
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State | AZ
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Zip | 86429-5249
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Country | US
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Telephone | 928-419-1036
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Fax | 928-404-2213
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Provider Business Mailing Address
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Address Line | 211 MOSER AVE UNIT 2
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City | BULLHEAD CITY
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State | AZ
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Zip | 86429-5248
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Country | US
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Telephone | 928-419-1036
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Fax | 928-404-2213
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Authorized Official
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Title or Position | CEO
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Name | MS. MARIE BRIDGET MORAN
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Credential | PMHNP-BC
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Telephone | 928-404-2213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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